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).•'�G.COL <br /> Z:•. EmgRC MENTAL HEALTH APARTMENT <br /> �,•rF� H�' SAN JOAQUIN COUNTY <br /> Donna K.Haran,R.E.H.S. Program Coordinators <br /> Director 600 East Main Street, Stockton, California 95202 Kasey L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Robert McClellon,R.E.H.S. <br /> Weh:WWW.sjgov.org/ehd Jeff Carruesco,R.E.H.S. <br /> Linda Turkatte,R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> ---- ART-1 — - - - --- <br /> GENERAL SITE WORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: C!_C% Zi �(o ?��c G 1. Chemicals Hazards <br /> Address: <br /> ❑Carcinogens: <br /> Contact Person: <br /> ❑Corrosives: <br /> Phone#l: �t-{-` - 7,2 7 '3 <br /> ❑Dusts: <br /> Proposed Date of investigation/inspection: '7- 1 Z I( ❑Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrative of inspection activity: <br /> ❑Inorganic Gases: <br /> ❑New UST installation ❑UAR Investigation 0 Metals: <br /> ❑Tank Closure in Place ❑Tank/Pipe Repair ❑Oxidizers: <br /> ElTank/Pipe Removal ❑Re-excavation ❑PCBs: <br /> El Sampling ❑Boring/Monitoring Well installation El Other: <br /> --f57lazardous Waste inspection ❑Tiered Permitting inspection <br /> PART III <br /> 3. Specific Site hrfonnation: 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: <br /> ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑None(see below) <br /> Documented Groundwater contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health&Safety Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑B C ®D <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Hard Hat <br /> ❑Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots <br /> '_E'Excavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls <br /> B Handling and Transfer of a Hazardous Substance(fire,explosions,etc.): ®Hag Protection <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical injury&trauma resulting from moving A/P Cartridge: <br /> equipment): ®Safety vest <br /> ❑Other(specify): <br /> ❑Two-way communication <br /> El Other(specify): <br /> 7. Anticipated Biological Hazards: <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants PART IV <br /> ❑Other/Unknown(specify): PLAN APPROVAL�,� <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared b : Z Z• /1 <br /> e.g.,power lines,integrity of dikes,terrain,etc.): Date: <br /> Plan Approved by: �� Date: �( <br /> i <br /> EH 23081(12/6/2010) I <br />