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ENVIRONMENTAL HEALTH)6EPARTMENT <br /> OPOU(ry C <br /> ` SAN JOAQUIN COUNTY <br /> Donna K. Heran, R.E.H.S. Program Coordinators <br /> # fi iIT�T 304 East Weber Avenue,Third Floor car sgrgtnan, R.E.H.S. <br /> Laurie Al, ot�2,k.E.H � ��fy9a DEPA�(� s, R.E.H.S., R.D.I. <br /> • c9�lcpai+`v Assistant Director SITE H 'C0n7p"�" '3}' Margaret Lago.E.H. E.H.S. <br /> � Robert McClellon, R.E.H.S. <br /> Fax: (209)464-0138 Jeff Carruesco,R.E.H.S. <br /> Website:www.sjgov.org/ehd/ Kasey Foley, R.E.H.S. <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Altec Brake Systems 1. Chemicals Hazards <br /> Address:4274 Pock In.,Ste 100,Stockton <br /> Contact Person:Brian McClendon Phone No:982-1814 ®Carcinogens:waste oil,used absorbents <br /> ❑ <br /> Sweeps Number: Corrosives: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspection:April 2007 <br /> ❑Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation.. ❑UAR Investigation. <br /> [I Tank Closure in Place.. ❑Tank/Pipe R ®Metals:Brake grinding dust <br /> Repair. <br /> ❑Tank/PI Removal. ❑Oxidizers: <br /> Tank/Pipe ❑Re-excavation. <br /> ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®Hazardous waste inspection ❑ Sampling <br /> ❑Tiered Permitting inspection PART III <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:Remanufacturer of Truck Brake Shoes <br /> ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑Other,specify. <br /> Evidence ofleaks/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 /> Level of Protection: ❑A ❑B ❑C So <br /> 6. Potential Health and Safety S Hard Hat. <br /> Physical Concerns:(check all that apply&describe) S Safety Glasses/gogglm. <br /> ❑Heat or Cold Stress: °F(high ambient temp.) S Steel toed/shank shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: S Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): ❑Tyvek. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, ❑Respirator. ❑APR ❑SCBA <br /> etc..): AT cartridge: <br /> ❑Confined space entry:(explosions): S 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: <br /> ❑Snakes ❑Insects [I Rodents ❑Poisonous Plants Plan Prepared by:Ray von Flue Date:4/17/07 <br /> ❑Other/Unknown(specify): <br /> Plan Approved by: pate; <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 />