Laserfiche WebLink
bpulry <br /> ENVIRON1vIENTAL HEALTH DEPARTMENT <br /> Donna K. <br /> SAN JOAQUIN COUNTY <br /> c/lord Program Coordinators <br /> Director <br /> r 600 East Main Street, Stockton,California 95202 Kaley L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Robert McClellon,R.E.H.S. <br /> JeffCarruesco,RE.H.S. <br /> Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE ORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: Ir, L (� <br /> 1. Chemicals Hazardssf� �dJL <br /> Address:��o2d�. gap' . iCarchogens; _J l4'l"7 <br /> Contact Person: '" ❑Corrosives: <br /> Phone#: O ❑Dulls: <br /> Proposed Date of investigation/inspection: ❑Explosives: <br /> Plammables: W.' <br /> 2. Description and brief narrative of inspection activity: dhu rganic Gases: <br /> ❑New UST installation ❑UAR Investigation ❑Metals: <br /> ❑Tank Closure in Place ❑Tank/Pipe Repair ❑Oxidizers: <br /> ❑Tank/Pipe Removal ❑Re-excavation ❑PCBs: <br /> �0 sampling ❑Boring/Monitoring Well installation ❑Other. <br /> Hazardous Waste inspection ❑Tiered Permitting inspection <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all <br /> Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided): <br /> ❑Combustible Gas/Oxygen Meter <br /> ❑Detector Tubes(specify): <br /> 4. Type of Operation:��J t 1.1 V I LIaV.! ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> S. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination: ❑YES ❑NO Rlone(see below) <br /> Documented Groundwater contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health&Safety Physical Concerns:(✓all that apply&describe) Level of Pmtectiom ❑A ❑ B ❑C ® D <br /> ❑Heat or Cold Stress: OF(high ambient temp.) ®Hard Hat <br /> ❑Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots <br /> ,,❑...,,,��_E"""xcavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls <br /> ��� <br /> l�ttandling and Transfer of a Hazardous Substance(tare,explosions,etc.):_ ®Hearing protection <br /> / _ ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> Heavy equipment(pphykic mlury& uma resulting from movimg A/P Cartridge: <br /> equipment): N10 AU f= yy0�Safety vest <br /> ❑Other(specify): i lwo-way communication ff L&VZk- <br /> ❑Other(specify): <br /> 7. Anticipated Biological FLezards: <br /> ,�+�,pakeshtsects Rodents ❑Poisonous Plants PART IV <br /> ❑Other/Unknown(specify): PLAN APPROVAL <br /> 8. Narrative(provide all information which could impact Health and Safety, plan Prepared Dale: 2� <br /> e.g.,power lines,integrity of dikes,terrain,etc.): 'n <br /> Plan Approved by: J � Dine: <br /> EH23081(8/112011) <br />