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ENVIRON MENTAL HEALTHIMPARTMENT <br /> SAN JOAQUIN COUNTY <br /> C. Unit Supervisors <br /> Donna K.Heran, E.H,S. <br /> in: :< R 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> Director Mike Huggins,R.E.H.S.,R.D.I. <br /> Al Olsen,R.E.H.S. Stockton, California 95202-2708 <br /> • c.. v • <br /> Program Manager Douglas W.Wilson,R.E.H.S. <br /> g ' Telephone: (209) 468-3420 Margaret rio,R.E.H.S. <br /> Laurie A.CotuHa,RE.H.S. <br /> Program Manager Fax: (209) 464-0138 Robert M R.E.H.S. <br /> Mark Bare 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:Lodi USD Bus Maintenance 1. Chemicals Hazards <br /> Address:820 S.Cluff Avenue,Lodi,C <br /> ®Carcinogens: <br /> Contact Person:Steve 7_imbelmann Phone No:f209, 33) 17179 ❑Corrosives: <br /> Sweeps Number: E Dusts: <br /> Proposed Date of investigation/inspection:March 11.2004 ❑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 kquipment(note:Monitoring instruments must be used for all <br /> Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided) <br /> Other. ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:School Bus Maintenance ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> S. Release History: E]Other,specify. <br /> Evidence of leaks!soil Contamination: El YES El NO <br /> If monitoring instruments are not used,rationale or activity/area restrictions- <br /> Documented Groundwater contamination: ❑YES ❑NO — T <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C ED <br /> 6. Potential Health and Safety E Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ® Safety Glasses/goggles. <br /> E <br /> El Hear or Cold Stress: °F(high ambient temp.) Steel toed/shank shoes or boots. <br /> ❑F <br /> ®Noise Sources: EQUIPMENT lame retardant coveralls. <br /> ❑Oxygen Deficiency: ® Hearing protection. <br /> ❑ <br /> [3 Excavation:(falls,trips,slipping,cave-ins): Tyvek. <br /> ❑ <br /> ❑Handling and Transfer of a.Hazardous Substance:(fire,explosions, El Respirator: El APR SCBA <br /> ctc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): E Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ®Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: 1 `tl <br /> Pian Prepared by Date: /6 <br /> ❑Snakes ❑ Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved 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 />