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ENVIRONMENTAL HEALTH DEPARTMENT 1. Site Name: LLNL Site 300 Address: Corral Hollow, Tracy, CA Contact Person: Stan Terusake Phone No: (925) 422-1539 Sweeps Number: Proposed Date of investigation/inspection: August 2. 2004 2. Description and brief narrative of inspection activity: ❑ New UST installation. ❑ UAR Investigation. ❑ Tank Closure in Place. ❑ Tank/Pipe Repair. ❑ Tank/Pipe Removal. ❑ Re -excavation. ❑ Installation of Borings / Monitoring Wells. ❑ Hazardous Waste Inspection ❑ Sampling. 3. Specific Site Information: Tank No.: Tank Capacity: Tank Content: Tank Age: Other: 4. Type of Operation: Research 5. Release History: Evidence of leaks / soil contamination: ❑ YES ❑ NO Documented Groundwater contamination: ❑ YES ❑ NO Background and description of any previous investigation or incidence: 6. Potential Health and Safety Physical Concerns: (check all that apply & describe) ❑ Hear or Cold Stress: °F (high ambient temp.) ® Noise Sources: EQUIPMENT ❑ Oxygen Deficiency: ® Excavation: (falls, trips, slipping, cave-ins): ❑ Handling and Transfer of a Hazardous Substance: (fire, explosions, etc..): ❑ Confined space entry: (explosions): ® Heavy equipment (physical injury & trauma resulting from moving equipment): ❑ Other, specify Anticipated Biological Hazards: ® Snakes ❑ Insects ❑ Rodents ® Other/Unknown (specify): ❑ Poisonous Plants 8. Narrative (provide all information which could impact Health and Safety, e.g., power lines, integrity of dikes, terrain, etc.): UNKNOWN EH 23081 (12/17/2002) Chemicals Hazards ® Carcinogens: _ ❑ Corrosives: ® Dusts: ® Explosives: ® Flammables: ❑ Inorganic Gases: ® Metals: ® Oxidizers: ❑ PCB's: PART III REQUIRED PERSONAL PROTECTIVE EQUIPMENT I . Monitoring Equipment (note: Monitoring instruments must be used for all operations unless appropriate rationale or restrictions are provided) ❑ Combustible Gas/Oxygen Meter. ❑ Detector Tubes (Specify). ❑ Photo ionization Detector. ❑ Organic Vapor Analyzer. ❑ Other, specify. If monitoring instruments are not used, rationale or activity / area restrictions: 2. Personal Protective Equipment Level of Protection: ❑ A ❑ B ❑ C ® D ® Hard Hat. ® Safety Glasses/goggles. ® Steel toed/shank shoes or boots. ❑ Flame retardant coveralls. ® Hearing protection. ❑ Tyvek. ❑ Respirator: ❑ APR ❑ SCBA A/P cartridge: ® Safety vest. ® Two-way communication. PART IV - PLAN APPROVAL Plan Prepared by:e, Date: Plan Approved by: Date: SAN JOAQUIN COUNTY a ' Z Donna K. Heran, R.E.H.S. 304 East Weber Avenue, Third Floor Unit Supervisors P Carl Borgrnan, R.E.H.S. • - Director Al Olsen, R.E.H.S. Stockton, California 95202-2708 Mike Huggins, R.E.H.S., R.D.I. •. P Pro am Manager Program Telephone: (209) 468 -3420 Douglas W. Wilson, R.E.H.S. Margaret Lagorio, R.E.H.S. Laurie A. Cotulla, RE.H.S. Fax: (209) 464-0138 Robert McClellon, R.E.H.S. Program Manager Mark Barcellos, R.E.H.S. SITE HEALTH AND SAFETY PLAN PART I PART II GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS 1. Site Name: LLNL Site 300 Address: Corral Hollow, Tracy, CA Contact Person: Stan Terusake Phone No: (925) 422-1539 Sweeps Number: Proposed Date of investigation/inspection: August 2. 2004 2. Description and brief narrative of inspection activity: ❑ New UST installation. ❑ UAR Investigation. ❑ Tank Closure in Place. ❑ Tank/Pipe Repair. ❑ Tank/Pipe Removal. ❑ Re -excavation. ❑ Installation of Borings / Monitoring Wells. ❑ Hazardous Waste Inspection ❑ Sampling. 3. Specific Site Information: Tank No.: Tank Capacity: Tank Content: Tank Age: Other: 4. Type of Operation: Research 5. Release History: Evidence of leaks / soil contamination: ❑ YES ❑ NO Documented Groundwater contamination: ❑ YES ❑ NO Background and description of any previous investigation or incidence: 6. Potential Health and Safety Physical Concerns: (check all that apply & describe) ❑ Hear or Cold Stress: °F (high ambient temp.) ® Noise Sources: EQUIPMENT ❑ Oxygen Deficiency: ® Excavation: (falls, trips, slipping, cave-ins): ❑ Handling and Transfer of a Hazardous Substance: (fire, explosions, etc..): ❑ Confined space entry: (explosions): ® Heavy equipment (physical injury & trauma resulting from moving equipment): ❑ Other, specify Anticipated Biological Hazards: ® Snakes ❑ Insects ❑ Rodents ® Other/Unknown (specify): ❑ Poisonous Plants 8. Narrative (provide all information which could impact Health and Safety, e.g., power lines, integrity of dikes, terrain, etc.): UNKNOWN EH 23081 (12/17/2002) Chemicals Hazards ® Carcinogens: _ ❑ Corrosives: ® Dusts: ® Explosives: ® Flammables: ❑ Inorganic Gases: ® Metals: ® Oxidizers: ❑ PCB's: PART III REQUIRED PERSONAL PROTECTIVE EQUIPMENT I . Monitoring Equipment (note: Monitoring instruments must be used for all operations unless appropriate rationale or restrictions are provided) ❑ Combustible Gas/Oxygen Meter. ❑ Detector Tubes (Specify). ❑ Photo ionization Detector. ❑ Organic Vapor Analyzer. ❑ Other, specify. If monitoring instruments are not used, rationale or activity / area restrictions: 2. Personal Protective Equipment Level of Protection: ❑ A ❑ B ❑ C ® D ® Hard Hat. ® Safety Glasses/goggles. ® Steel toed/shank shoes or boots. ❑ Flame retardant coveralls. ® Hearing protection. ❑ Tyvek. ❑ Respirator: ❑ APR ❑ SCBA A/P cartridge: ® Safety vest. ® Two-way communication. PART IV - PLAN APPROVAL Plan Prepared by:e, Date: Plan Approved by: Date: