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ENVIROENTAL HEALTHSDEPARTMENT <br /> >° 0o SAN JOAQUIN COUNTY <br /> • <br /> UnitSupervisors <br /> Donna K Heran,R.E.H.S. <br /> mi :< Director 304 East Weber Avenue, Third Floor Carl Boins,R. .H.S., S. <br /> - - A]Olsen,R.E.H.S. Stockton, California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> ••r. - 'P• <br /> ProgramMana Douglas W.Wilson,R.E.H.S. <br /> 9�/FORNx Manager <br /> otuua,RE.Hs. Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie <br /> Program Manager Fax: (209) 464-0138 Robert McClellan,R.E.H.S. <br /> Mark Bareellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PARTI PARTII <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Lathrop Chevron 1. Chemicals Hazards <br /> Address:140 Lathrop Road.Lathrop ❑Carcinogens: <br /> Contact Person:Ames Mabalot Phone No:(2091982-577 9 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:October 14,2004 ®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 /> Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided) <br /> Other: ❑Combustible Cru/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Gas Station ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> ❑ <br /> 5. Release History: Other,specify. <br /> Evidence of leaks/soil contamination: <br /> ❑YES ®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 /> 6. Potential Health and Safety Level of Protection: ❑A ❑B ❑C OD <br /> Physical Concerns:(check all that apply&describe) ®Hard Hat. <br /> ® <br /> ❑Hear or Cold Stress: °F(high ambient temp.) Safety Glasses/goggles. <br /> ®Noise Sources:Traffic ®Sleet t anshoes or boots. <br /> El Oxygen Deficiency: El Flame retardetardantt coveralls. <br /> ®Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Tyvek. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> Respirator: El APR [ISCBA <br /> etc..): <br /> ❑Confined space entry:(explosions): A/P cartridge: <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ®Safety vest. <br /> equipment): ®Two-way communication. <br /> ❑Other,specify <br /> PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: / <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants Plan Prepared b . Dater <br /> ❑Other/Unknown(specify): <br /> 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 />