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ENVIRONMENTAL HEALTAEPARTMENT <br /> p4�'IN SAN JOAQUIN COUNTY Unit Supervisors <br /> Donna IC Heran,RE.H.S. Carl Bergman,R.E.H.S. <br /> '.i Director 304 East Weber Avenue,Third Floor Mike Huggins,R.E.H.S.,R.D.I. <br /> Al Olsen,RE.H.S. Stockton, California 95202-2708 Douglas W.Wilson,R.E.H.S. <br /> ' Program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> • 4crkoawr Laurie A.Cotulla,RE.H.S. Robert McClellan,R.E.H.S. <br /> Program Manager Fax: (209) 464-0138 Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PARTI PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:CITY GARAGE 1. Chemicals Hazards <br /> Address:604 W.I ITH STREET TRACY CA 95376 ❑Carcinogens: <br /> Contact Person:JOHN DITURI Phone No:(209)835-3741 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:MAY 30 2003 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. ®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 /> ®Hazardous Waste Inspection ❑Sampling. PART III <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 3. Specific Site Information: l. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank No.: Tank 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:MOTORCYCLE 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 ®D <br /> ®Hard Hat. <br /> 6. Potential Health and Safety ®Safety Giums/goggles. <br /> Physical Concerns:(check all that apply&describe) ®Steel toed/shank shoes or boots. <br /> ❑Hear or Cold Stress: OF(high ambient temp.) ❑Flame retardant coveralls. <br /> ®Noise Sources: ®Hearing 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 /> etc..): ®Safety vest. <br /> ❑Confined space entry:(explosions): ®Two-way communication. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving <br /> equipment): PART IV-PLAN APPROVAL <br /> ❑Other,specify <br /> 7. Anticipated Biological Hazards: <br /> Plan Prepared by' Date' d <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan A PProved 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 23091(12/17/2002) <br />