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SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Tower Park ResomMarina 1. Chemicals Hazards <br /> Address: 14900 W.Hwy 12 Lodi,CA 95242 <br /> ®Carcinogens:diesel,oil,gasoline <br /> Contact Person:Rhonda Fitch Phone No:209 943-5656 ❑Corrosives: <br /> Sweeps Number: <br /> ❑ Dusts: <br /> Proposed Date of investigation/inspection:6-4-10 ❑Explosives: <br /> ®Flammables:diesel,oil,gasoline <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. <br /> ®Metals:drainedused oil filters <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑ Installation of Borings/Monitoring Wells. ❑Other: <br /> ®HW inspection <br /> 3. Specific Site information: PART III <br /> Tank No.: Tank Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Tank Age: I. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:Resort Marina ❑Detector Tubes(Specify). <br /> 5. Release History: ❑Photo ionization Detector. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑Organic Vapor Analyzer. <br /> ❑ <br /> Documented Groundwater contamination: ❑YES F1 NO Other,specify. <br /> Background and description of any previous investigation or incidence: if monitoring instruments are not used,rationale or activity/area restrictions: <br /> 6. Potential Health and Safety 2. Personal Protective Equipment <br /> Physical Concerns:(check all that apply&describe) Level of Protection: ❑A ❑B [3 C OD <br /> F1Heat or Cold Stress: °F(high ambient temp.) Hard Hat. <br /> ®Safety Glasses/goggles. <br /> ®Noise Sources:traffic. <br /> ®Steel toed/shank shoes or boots. <br /> E]Oxygen Deficiency: <br /> ❑Excavation:(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls. <br /> ®Hearing protection. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> etc..): ❑Tyvek. <br /> ❑Confined space entry:(explosions): ❑ Respirator: ❑ APR ❑SCBA <br /> ❑Heavy equipment(physical injury&trauma resulting from moving A/P cartridge: <br /> equipment): Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> a. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> Snakes 0 Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Prepared by:Aris Cacanit Date:June 4,2010 <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Approved by: VA Date: ✓ �L� <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(12/13/2002) <br />