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0 9 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Lodi Unified School District Maintenance Shop 1. Chemicals Hazards <br /> Address: 31 N Pacific Ave Lodi carcinogens: <br /> Contact Person:Matifanger Phone No:209-331-7181_ ,❑"Corrosives: <br /> Sweeps Number: E Dusts: <br /> Proposed Date of investigation/inspection:5/11/04 E Explosives: <br /> ff 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 /> operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age: <br /> ❑Combustible Gas/Oxygen Meter. <br /> Other: <br /> ❑Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 4. Type of Operation: School Wharehouse <br /> ❑Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> 5. Release History: If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Evidence of leaks/soil contamination: ❑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: El El El Ia u <br /> ❑Hard Hat. <br /> 6. Potential Health and Safety ❑Safety Glasses/goggles. <br /> Physical Concerns:(check all that apply&describe) 9§teel toed/shank shoes or boots. <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ❑Flame retardant coveralls. <br /> ❑Noise Sources: <br /> ❑Hearing protection. <br /> ❑Oxygen Deficiency: ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): ❑Respirator: ❑APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, A/P cartridge: <br /> etc..): <br /> ❑Safety vest. <br /> ❑Confined space entry:(explosions): <br /> El Two-way communication. <br /> ElHeavy equipment(physical injury&trauma resulting from moving <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by:John Jackson Date:5/10/04 <br /> ❑Snakes [sects El Rodents El Poisonous Plants <br /> ❑Other/ kn`owhj(specify): 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.) <br /> EH 23081 (02/19/03) <br />