Laserfiche WebLink
RQUIN <br /> t ENVIRO ENTAL HEALTH DEPARTMENT <br /> Donna K.Heron,R.E.H.S. SAN JOAQUIN COUNTY Program Coordinators <br /> Director 600 East Main Street, Stockton, California 95202 Kasey L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Far(209)468-3433 Robert McClellon,R.E.H.S. <br /> Web:wwwsjgov.org/ehd Jeff Can uesco,R.E.H.S. <br /> SITE HEALTH&SAFETY PLAN <br /> PARTI PARTII <br /> GENERAL SITE�INNFOOR"MATION /y /_'y, L EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: ,_fes 92� 0 nQ /_2�/1//�G� 1. Chemicals Hazards <br /> Address: �'02O �s��z ICarcinogens: <br /> Contact Person:'�M ❑Corrosives: <br /> Phone H: (cv� 0.06—.eWM - e [I Dusts: <br /> Proposed Date of investigation/inspection: ❑Explosives: �� �, <br /> Wammables: Y�rSUL3P,i? ^v r rlWIL <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gas <br /> ❑New UST installation ❑UAR Investigation ❑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 /> yq,yazardous 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 /> Other: ❑Combustible Gas/Oxygen Meter <br /> L ❑Detector Tubes(specify): <br /> 4. Type of Operation: h�L �i,/Ih//���.//�17 ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> S. Release History: ❑Other(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 OD <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Hard Hat <br /> Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots <br /> xcavation falls,trips,slipping, ❑Flame retardant coveralls <br /> ( p Aping,cave-ins): <br /> andling and Transfer of a Hazardous Substance(fire,explosions,etc.):, ®Hearing protection <br /> zar <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> Neeavy equipment(physical injury&trauma resulting from moving A/P Cartridge: <br /> uipment): ®Safety vest <br /> ❑Other(specify): Two-way communication 7477 LL <br /> ❑Other(specify): <br /> 7. Anticipated Biological H rds: <br /> Snakes Insects Rodents ❑Poisonous Plants PART IV <br /> ❑Other/Unknown(specify): PLAN APPROVAL <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Prepare Date: <br /> e.g.,power lines,integrity of dikes,terrain,etc.): 1 _ <br /> Plan Approved by: N/N Date:6'(O•ty <br /> EH 23081 (4/7/2010) <br />