Laserfiche WebLink
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:West[ane Chevron L Chemicals Hazards <br /> Address:4747 West Lane,Stockton ®Carcinogens:used fuel filters,used test fluid <br /> Contact Person:Surinder Saini Phone No:472-1639_ ❑Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection:October 8,2007 ❑Explosives: <br /> ®Flammables:used absorbent <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 /> ❑Tiered Permitting inspection <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 3. Specific Site Information: <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 Meer. <br /> Other: <br /> ❑Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 4. Type of Operation:Retail Gasoline Outlet ❑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: ❑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 OD <br /> ®Hard Hat. <br /> 6. Potential Health and Safety ®Safety Glasses/goggles. <br /> Physical Concerns:(check all that apply&describe) <br /> ®Steel rued/shank shoes or boots. <br /> ❑Heat or Cold Stress: OF(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, AT cartridge: <br /> etc..): <br /> F1 Confined space entry:(explosions): ®Safety vest. <br /> ❑ ❑Two-way communication. <br /> Heavy equipment(physical injury&traumresulting from morng <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by:Ray von Flue Date: 10/8/07 <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(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 />