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PgUrN <br /> ENVIRO]WENTAL HEALTIAIEPARTMENT <br /> Donna K.Heran,R.E.H.S. SAN JOAQUIN COUNTY <br /> • Cad/PbNNvP• Program Coordinators <br /> Director <br /> 600 E. Main Street Carl Borgman,R.E.H.S. <br /> Laurie A.Cotulla,R.E.H.S. Stockton, California 95202 Mike Huggins,R.E.H.S.,R.D.I. <br /> Assistant Director Kasey L.Foley,R.E.H.S. <br /> Telephone: (209)468-3420 Margaret Lagorio,R.E.H.S. <br /> Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> Web: www.sjgov.org/ehd Jeff Carruesco,R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> L Site Name:SJ REGIONAL TRANSIT L Chemicals Hazards <br /> Address:1533 E.LINDSAY ST ❑Carcinogens: <br /> Contact Person:CHRIS DURANT Phone No:948-5566 ®Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection:06/12/07 ❑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 IH <br /> ❑Tiered Permitting inspection <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 /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Bus Maintenance Facility ❑Photo ionization Detector. <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: El YES ❑NO <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 ND <br /> Hard Hat. <br /> 6. Potential Health and Safety ® <br /> Physical Concerns:(check all that apply&describe) ®Safety ed/Glashank boe s. <br /> ®Steel toed/shank shoes or boots. <br /> ❑Heat or Cold Stress: OF(high ambient temp.) <br /> ❑Flame retardant coveralls. <br /> ❑Noise Sources: <br /> Hearing protection. <br /> ❑Oxygen Deficiency: ® <br /> ❑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): ®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: Plan Prepared by: Date: t2 <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants - (I Q L <br /> ❑Other/Unknown(specify): Plan Approved by: �TW"9�` Date: -&(07 <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(02/19/03) <br />