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40 00 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> . Site Name:Amberland Composites LLC 1. Chemicals Hazards <br /> Address:3632 Duck Creek Dr.,Stockton CA <br /> ®Carcinogens:waste resins,used absorbents <br /> Contact Person:Vachara Tantiyavarong Phone No:460-1600 <br /> ❑Corrosives: <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspection:February 2009 <br /> ❑Explosives: <br /> 2. Description and brief narrative of inspection activity: ❑F'lammables: <br /> ❑New UST installation.. ElInorganic Gases: <br /> ❑UAR Investigation. <br /> ❑Tank Closure in Place.. ❑Metals: <br /> ❑Tank/Pipe Repair. <br /> ❑Tank/Pipe Removal. ❑Oxidizers: <br /> ❑ Re-excavation. <br /> ElInstallation of Borings/Monitoring Wells. ❑PCB's: <br /> ❑ Hazardous waste inspection ❑ Sampling <br /> ❑Tiered Permitting inspection PART III <br /> 3. Specifie Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: I. Monitoring Equipment(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:Fiberglass Fabrication ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑Other,specify. <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 ®D <br /> 6. Potential Health and Safety ❑Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Steel toed/shank shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: <br /> Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): ❑Tyvek. <br /> ❑ SCBA❑ <br /> El Handling and Transfer of a Hazardous Substance:(fire,explosions, Respirator: F1 APR. <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): G3 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: Plan Prepared by:Ray von Flue Date:2/18/09 <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.) <br /> EH 23081 (02/19/03) <br />