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ENVIRONMENTAL HEALTH%EPARTMENT <br /> p4u'" SAN JOAQUIN COUNTY <br /> so_�.coc Unit Supervisors <br /> Donna K.Horan,R.E.H.S. <br /> �. 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> Director Mike Huggins,R.E.H.S.,R.D.I. <br /> All Olsen,R.E.H.S. Stockton, California 95202-2708 Douglas W.Wilson,R.E.H.S. <br /> • c .0 N v • Program Manager Telephone: (209)468-3420 Margaret Lagorio,R.E.H.S. <br /> 9 FOR ` <br /> Laurie A.Co Man ILE.xs. Fax: (209) 464-0138 <br /> Program Manager Robert McClelloq R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN etn S. <br /> PARTI PARTII <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:HIGHWAY PATROL#266 1. Chemicals Hazards <br /> Address:385 W GRANT LINE RD,TRACY.CA 95376 ❑Carcinogens: <br /> Contact Person:WILLIAM DUNCAN Phone No:(209)835-8920 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:JULY 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 /> 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 /> operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age: <br /> ❑Combustible Gas/Oxygen Meter. <br /> Other: <br /> ❑Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 4. Type of Operation:MOTOR REPAIR <br /> ❑Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> 5. Release History: <br /> 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 dcscripfion of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A EIB ❑C E D <br /> _ E Hard Hat. <br /> Potential Health and Safety <br /> E Safety Glasses/goggles. <br /> Physical Concerns:(check all that apply&describe) <br /> E Steel toed/shankhankshoes or boots. <br /> ❑Hear or Cold Stress: °F(high ambient temp.) ❑Flame retardant coveralls. <br /> E Noise Sources: <br /> E Hearing protection. <br /> ❑Oxygen Deficiency: ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Respirator: El APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> A/P cartridge: <br /> etc..): <br /> ❑Confined space entry:(explosions): E Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving E Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by'( 6 Date: <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.):UNKNOWN <br /> EH 23081(12/17/2002) <br />