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STATE OF CALIFORNIA- <br /> DEPARTMENT OF CALIFORNIA HIGHWAY PATROL <br /> DES CONTROL NUMBER <br /> INCIDENT ACTION PLAN/SITE SAFETY PLAN <br /> CHP 4071(New 5-15)OPI 062 Refer to HPM 84.2,Chapter 2 18-1161 <br /> INCIDENT DATE(MM/DDNY" INCIDENT TIME(HOURS) <br /> 02/22/2018 0415 <br /> INCIDENT OCCURRED ON ❑AT INTERSECTION WITH <br /> Mountain House Parkway <br /> Byron Road ®OR North of <br /> AREA DESCRIPTION <br /> Two lane county road with dirt and grass fields on both sides. <br /> INCIDENT COMMANDER SITE SAFETY OFFICER <br /> Sergeant Lecce Greg Quilenderino, Mountain House Fire Department <br /> INCIDENT ACTION PLAN <br /> GENERAL INFORMATION: • PROTECT LIFE, ENVIRONMENT,AND PROPERTY. <br /> • COMPLY WITH SECTION 5192(q),TITLE 8, CALIFORNIA CODE OF REGULATIONS. <br /> • IDENTIFY THE INCIDENT COMMANDER AND SAFETY OFFICER. <br /> PROCEDURES FOR HANDLING EMERGENCY INCIDENTS: <br /> ® Identify all hazardous substances or conditions present. <br /> ® Based upon identification, implement appropriate operations, and assure use of proper personal protective equipment. <br /> ❑ Ensure personnel exposed to inhalation hazard wear a self contained breathing apparatus. <br /> ❑ Limit the number of personnel on-site, but use the buddy system. <br /> ❑ Ensure back-ups and standby emergency medical services are available. <br /> ❑ Designate a safety officer with knowledge of safety operations. <br /> ❑ Implement appropriate decontamination. <br /> SITE SAFETY PLAN <br /> GENERAL INFORMATION: • PROTECTION OF LIFE IS THE HIGHEST PRIORITY. <br /> • ENSURE ALL PERSONNEL ARE BRIEFED ON OPERATIONS AND SAFETY BEFORE WORK BEGINS. <br /> • NO PERSON SHALL EXCEED THEIR LEVEL OF TRAINING, CAPABILITIES, OR RESOURCES. <br /> CHEMICALrrRADE NAME UN DOTHAZARD QUANTITY RELEASED EXTENT OF RELEASE PHYSICAL PHYSICAL STATE <br /> NUMBER CLASS (LBS.,GAL.,ETC.) STATE STORED RELEASED <br /> HVDO Chlorite Solution 1791 8 180 pounds Outside vehicle Liquid Liquid <br /> CONTAINER TYPE CONTAINER CAPACITY(LBS.,GAL.,ETC.) CONTAINER MATERIAL LEVEL OF CONTAINER <br /> Cargo tank 50,000 pounds Aluminum/Aluminum alloys Above ground <br /> CHEMICALTTRADE NAME UN DOTHAZARD QUANTITYRELEASED EXTENT OF RELEASE PHYSICAL PHYSICAL STATE <br /> NUMBER CLASS (LBS.,GAL,ETC.) STATE STORED RELEASED <br /> CONTAINER TYPE CONTAINER CAPACITY(LBS.,GAL.,ETQ) CONTAINERMATERIAL LEVEL OF CONTAINER <br /> MEDICAL SIGNS OF EXPOSURE: <br /> ❑ Nausea/Vomiting ❑Coughing <br /> ❑ Dehydration ❑Tingling/Numbness of extremities <br /> ❑Trouble breathing ❑ Diarrhea <br /> ® Skin irritation ❑ Unconsciousness <br /> ❑ Dizziness ❑Anxiety <br /> ❑Confusion ❑ Blurred/Double vision <br /> ❑ Other symptoms: <br /> Page 1 of 2 An Internationally Accredited Agency Chp4071_0315.pd <br />