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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:Teresi Trucking Inc L Chemicals Hazards <br /> Address:900!6 Victor Rd Lodi CA 95240 S Carcinogens:OIL <br /> Contact Person:John Teresi. Phone No:209 368-2472 ❑Corrosives: <br /> Sweeps Number: S Dusts: <br /> Proposed Date of investigatioNinspection:June 4 2009 ❑Explosives: <br /> S Flammables:OH, <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 /> ®HW inspection PART III <br /> 3. Specific Site Information: <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 /> operations unless appropriate rationale or restrictions are provided) <br /> Other: <br /> ❑Combustible Gas/Oxygen Meter. <br /> [I Detector Tubes(Specify). <br /> 4. Type of Operation:1100 AgJffjg ! `T +N C](udvPhoto ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: <br /> ❑Other,specify. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contamination: ❑YES C]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 <br /> Hard Fla[. <br /> Physical Concerns:(check all that apply&describe) S <br /> ❑Heat or Cold Stress: OF(high ambient temp.) ®Safety d/sses/gooes. <br /> S Steel toed/shank shoes or boots. <br /> S Noise Sources:traffic ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: S Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Tyvek. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> ❑Respirator: E]APR C]SCBA <br /> eta.): <br /> ❑ <br /> Confined space entry:(explosions): AT cartridge: <br /> ❑Heavy equipment(physical injury At trauma resulting from moving S 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 by:Aris Cacaoit Date:June 4.2009 <br /> ❑Other/Unknown(specify): <br /> Plan Approved by: Date: <br /> S. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(12/17/2002) <br />