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aq.�.cA <br /> ENVIRAIENTAL HEALTH IRPARTMENT <br /> •e*�/F..yfi`Y SAN JOAQUIN COUNTY program Coordinators <br /> Donna K.Henan,RE.H.S. <br /> Director 600 East Main Street, Stockton,California 95202 Kase y L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Robert McClellon,R.E.H.S. <br /> Jeff Carruesco,R.E.H.S. <br /> Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. <br /> SITE HEALTH&SAFETY PLAN <br /> PARTI PART II <br /> GENERAL SITE INFORMATION.1�, L EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: 034 Ct�LY�d�I 'W 1. Chemicals Hazards <br /> Address: 8 Kiri 6k ISA a ❑Carcinogens:`iwL <br /> Contact Person: ::r" limno — AAAf• yiini1;hi.9 ()Pdf ❑Corrosives: <br /> Phone#, M—a�q 1 s [--]Dusts: <br /> Proposed Date of investigation/inspection: I ❑Explosives: <br /> ❑Flammables: Ih <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: ') t a( tp <br /> /drdY)Gt.r4' <br /> [I New UAR lnvestigatiun ❑ <br /> New UST installation <br /> Metals: <br /> ❑Tank Closure in Place ❑Tank/Pipe Repair ❑Oxidizers: <br /> ❑Tank/Pipe Removal ❑Re-excavation ❑PCBs: <br /> ❑Sampling ❑Boring/Monitoring Well installation ❑Other: <br /> ❑"iaaardous Waste inspection ❑Tiered Permitting inspection <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all <br /> Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided): <br /> OOrec; ❑Combustible Gas/Oxygen Meter <br /> ❑Detector Tubes(specify): <br /> 4. Type of Opemtion: C A jZ;9 -61-•J(� ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History: ❑mer(specify): <br /> Evidence of leaks/soil contamination: ❑YES []NO ❑None(see below) <br /> Documented Groundwater contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health&Safety Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ®D <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Hand Hat <br /> ❑Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots <br /> ❑Excavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls <br /> ❑Handling and Transfer of a Hazardous Substance(fire,explosions,etc.):. ®Hearing protection <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical injury&trauma resulting from moving AT Cartridge: <br /> equipment): ®Safety vest <br /> ❑Other(specify): ❑Two-way communication <br /> ❑Other(specify); <br /> 7. Anticipated Biological Hazards: <br /> ❑Snakes ❑Insects Cl Rodents ❑Poisonous Plants PART IV <br /> ❑ <br /> Other/Unknown(specify): PLAN APPROVALS <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared by:_' IVnn�M. Date: I� <br /> e.g.,power lines,integrity of dikes,remain,etc.): yy;� <br /> Plan Approved by: Date: <br /> EH 23081(5/9/2011) <br />