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ENVIRONMENTAL HEALTHODEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Donna K Heron,R.E.H.S. 304 Bor an,R.E.H.S. <br /> Director <br /> a: • 304 East Weber Avenue, Third Floor gm <br /> AI Olsen,RDouglas W.Wilson, <br /> E.H.S. Stockton, California 95202-2708 Mike Huggins, S.,R.D.I. <br /> R.E.H.S. <br /> • c�9ctFpeavP• Program Manager Telephone: (209) 468-3420 Margaret Lagotio,R.E.H.S. <br /> Laurie A.Co RE.H.S. <br /> Man Fax: (209)464-0138 Robert McClellon,R.E.H.S. <br /> Program Manager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Western Radiator Service of Lodi 1. Chemicals Hazards <br /> Address:12 S Cluff Avenue,Lodi,CA 95240 E Carcinogens: <br /> Contact Person:P5Vt ff .` Phone No:(209)333-3763 ❑Corrosives: <br /> Sweeps Number: E Dusts: <br /> Proposed Date of investigation/inspection:March 3 2004 ❑Explosives: <br /> E Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. E Metals: <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> E Hazardous Waste Inspection ❑Sampling. 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 /> operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age: <br /> Other:. <br /> [I Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Radiator Services ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> [I Other,specify. <br /> 5. Release History: <br /> Evidence of leaks/soil contamination: <br /> ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contamination: ❑YES ❑NO <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C On <br /> E Hard Hal. <br /> 6. Potential Health and Safety - <br /> Physical Concerns:(check all that apply&describe) E Safety Glasshoesi <br /> ❑Hear or Cold Stress: °F(high ambient temp.) E Steel toed/shanketardtshoes or boots. <br /> ❑Flame retardant coveralls. <br /> E Noise Sources: EOUIPMENT <br /> E]Oxygen Deficiency: E Hearing protection. <br /> ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Respirator: El APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, ,yp cartridge: <br /> etc..): <br /> ❑Confined space entry:(explosions): E Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving E Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared byV Date: <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by: Date: <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.):UNKNOWN <br /> EH 23081(12/17/2002) <br />