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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PARTI PARTII <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: Honker Cut Marine I. Chemicals Hazards <br /> Address: 11500 W Eieht Mile Rd - ❑Carcinogens: <br /> Contact Person: Phone No: E Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection: December 1,2003 ❑Explosives: <br /> E Flanunables: <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 /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 3. Specific Site Information: <br /> aci 1. Monitoring Equipment(note:Monitoring instruments must be used for al <br /> Tank Ca <br /> Tank No.: Capacity: operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age: ❑Combustible Gas/Oxygen Meter. <br /> Other: ❑Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 4. Type of Operation:Auto body repair ❑Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> 5. Release History: If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Evidence of leaks/soil contamination: ❑YES ❑NO <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 ND <br /> E Hard Hat. <br /> 6. Potential Health and Safety E Safety Glasses/goggles. <br /> Physical Concerns:(check all that apply&describe) E Steel toed/shank shoes or boots. <br /> ❑Heat or Cold Stress: °F(high ambient temp) ❑Flame retardant coveralls. <br /> E Noise Sources: E Heating protection. <br /> ❑Oxygen Deficiency: ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): ❑Respirator: ❑APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, A/P cartridge: <br /> eta.): ❑Safety vest. <br /> ❑Confined space entry:(explosions): ❑Two-way communication. <br /> [IHeavy equipment(physical injury&trauma resulting from moving <br /> equipment): <br /> PART IV-PLAN APPROVAL <br /> [I Other,specify 7 <br /> 7. Anticipated Biological Hazards: Plan Prepared by:Michelle Le—W—)11— .Date 11`l/ — <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by:-4"—/ <br /> Date: <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(02/19/03) <br />