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ql IV <br /> c: <br /> P` ' ENVIR041ENTAL HEALTIAEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> • �q' •.....• '�P• Donna K.Haran,R.E.H.S. Program Coordinators <br /> S <br /> tlFon`a 304 East Weber Avenue, Third Floor Carl Bergman,R.E.H.S. <br /> Director <br /> Laurie A.Cotulla,R.E.H.S. .Stockton, California 95202 Mike Huggins,R.E.H.S.,R.D.I. <br /> Kasey L.Foley,R.E.H.S. <br /> Telephone: (209)468-3420 <br /> Assistant Director Margaret Lagorio,R.E.H.S. <br /> Fax: (209)464-0138 Robert McClellan,R.E.H.S. <br /> Web: www.sjgov.org/ehd Jeff carrueseo,R.E.H.S. <br /> SITE HEALTH&SAFETY PLAN <br /> PART PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Stockton Scavenger 1. Chemicals Hazards <br /> Address:1240 Navy Dr. ❑Carcinogens: <br /> Contact Person: Phone No: ®Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:06-23-06 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation.. ❑LAR Investigation. ®Metals: <br /> ❑Tank Closure in Place.. ❑Tank/Pipe Repair. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®Hazardous waste inspection ❑ Sampling PART IH <br /> ❑Tiered Permitting inspection <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 /> 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:Waste pickup repair shoo ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: E]Other,specify. <br /> Evidence of leaks/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 ®D <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> [IHeat or Cold Stress: °F(high ambient temp.) ®Steel toed/shank shoes or boots. <br /> E]Noise Sources: ❑Flame retardant coveralls. <br /> ®Hearing protection. <br /> ❑Oxygen Deficiency: ' <br /> ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Respirator. El APR ❑SCBA <br /> ❑Handling and Transfer of Hazardous Substance:(fire,explosions, <br /> NP cartridge: <br /> etc..): <br /> ❑Confined space entry:(explosions): ®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: Plan Prepared by: Lori Lucas Date: 06-23-06 <br /> ❑Snakes ®Insects ®Rodents ❑Poisonous Plants 2 <br /> E]Other/Unknown(specify): Plan Approved by: Date: - 2 J LP <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 />