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x <br /> ENVIRONMENTAL HEALTH EFARTMENT <br /> a� N SAN JOAQUIN COUNTY <br /> c <br /> Unit Supervisors <br /> —o ?� Donna K.Ileran,R.E.H.S. P <br /> H Director 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S.. <br /> -• AI Olsen,R.E.H.S. Stockton, California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> • c'.. <br /> Program Manager Douglas W.Wilson,R.E.H.S. <br /> gi, aa` P g <br /> Laurie A.Cotulla,R.E.H.S. Telephone: (209) 468-3420 Mar aret Lagorio,R.E.H.S. <br /> Program Manager Fax:. (209) 464-0138 Robert McClellon,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN Mark Barcellos,R.E.H.S. <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Pacific Coast Industries 1. Chemicals Hazards <br /> Address:4101 N.Holly Drive Tracy,CA 95304 <br /> ®Carcinogens: <br /> Contact.Person:John Daniel Phone No:(209)836-9624 <br /> ❑Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection:March 19.2004 ❑Explosives: <br /> ®P'lammables. <br /> 2. Description and brief narrative of inspection activity: El Inorganic Gases: <br /> ElNew UST installation. ❑UAR Investigation. <br /> ❑Tank Closure in Place. E Metals: <br /> ❑Tank/Pipe Repair. <br /> El Oxidizers: <br /> ❑Tank/Pipe Removal. El Re-excavation. <br /> El PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ❑Hazardous Waste Inspection ❑Sampling. PART III <br /> 3. Specific Site Informadon: 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•, <br /> operations unless appropriate rationale or restrictions are provided) <br /> Other: ❑Combustible Gas/Oxygen Meter.. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Manufacture []Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑Other,specify_ <br /> Evidence of leaks/soil contamination: ❑YES <br /> ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <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 OD <br /> 6. Potentia]Health and Safety <br /> ®Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> E]Hear or Cold Stress: °F(high ambient temp.) Steel toed/shank shoes or boots. <br /> ®Noise Sources: EOUIPMENT ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: ® Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): F1 Tyvek. <br /> ❑ <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, Respirator: El APR ❑SCBA <br /> etc-): A/P cartridge: <br /> ❑Confined space entry.(explosions): ❑Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ❑Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: t'9 b <br /> Plan Prepared by: Date: <br /> 2 2 <br /> El Snakes El Insects ❑Rodents El Poisonous Plants <br /> ❑Other/Unknown(specify): <br /> Plan Approved by: Date:34q (� <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 />