Laserfiche WebLink
z�Rpul�v <br /> c �poZ <br /> ENVIRONTAL HEALTH DEPARTMENT <br /> +r;FoN� SAN JOAQUIN COUNTY <br /> Donna K.Haran,RE.H.S. Program Coordinators <br /> Director 600 East Main Street, Stockton, California 95202 Kasey L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Robert McClellon,R.E.H.S. <br /> Web:www.sjgov.org/ehd Jeff Carruesco,RE.H.S. <br /> Linda Turkatte,RE.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> PARTI PARTII <br /> GENERAL SITE INFORMATION ,r,�,� 1,„EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:_"-/17�,1Z�A./A`NYU a (.7Lt— (Iy�S/ar/1. Chemicals Hazards /� <br /> Address: ql S. NQIL)/�y'�JJ7t7,t � bCarcinogens: AN1h-fT"i(tD U <br /> Contact Person: koov. i�f'/n/♦ O <br /> ❑Corrosives: <br /> Phone#: / a ❑Dusts: <br /> Proposed Date of investigation/inspection: '—' ;L ❑Explosives: <br /> �yF'_lorgamcG kTOdl ' Q__ApJnO �p1'1V'jl fl <br /> 2. Description and brief narrative of inspection activity: t�rrorganic Gases <br /> ❑New UST installation ❑UAR Investigation ❑Metals: <br /> ❑Tank Closure in Place ❑Tank/Pipe Repair 'q Oxidizers: a��.Y1>115� <br /> ❑Tank/Pipe Removal ❑Re-excavation ❑PCBs: <br /> ❑Sampling ❑Boring/Monitoring Well installation ❑Other: <br /> Hazardous Waste inspection ❑Tiered Permitting inspection <br /> PARTIII <br /> 3. Specific 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 /> /� ��r� � _h_ /t I 1/��/� ❑Detector Tubes(specify): <br /> 4. Type of Operation: �IA.Y ULI. I Vl l' -�A 1 l,t,(I/ ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination: [I 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 E D <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 /> ❑Excavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls <br /> 87jIandling and Transfer of a Hazardous Substance(fire,explosions,etc.):. ®Hearing protection <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> Meavy equipment(physical injury&trauma resulting from moving AT Cartridge: <br /> equipment): _®Safety vest <br /> ❑Other(specify): )L,KT-wo-way communication f�J a}!Lt, <br /> ❑Other(specify): <br /> 7. Anticipated 'ological Hazards: <br /> -❑Snake- sects ❑Rodents ❑Poisonous Plants PARI'IV <br /> ❑Other/Unlmovm(specify): PLAN APPROVAL <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Preps <br /> e.g.,power lines,integrity of dikes,terrain,etc.): <br /> Plan Approved by: Date: <br /> EH 23081(5/52011) <br />