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0 6 <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I <br /> GENERAL SITE INFORMATION PART II <br /> 1. Site Name: B&C Painting Solutions EVALUATION OF POTENTIAL HAZARDS <br /> Address: 107 Val Dervin Parkway 1. Chemicals Hazards <br /> Contact Person:Nick Smeed Phone No:480-497-1401_ 1V Carcinogens: <br /> Sweeps Number: &Corrosives:hydrochloric acids <br /> Proposed Date of investigation/inspection:Monday July 6,2009 ❑Dusts: <br /> ❑Explosives: <br /> 2. Description and brief narrative of inspection activity: lammables:thinner <br /> ❑New UST installation. ❑UAR Investigation. Inorganic Gases: <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. Metals:metal grabber <br /> ❑Tank/Pipe Removal. ❑Re-excavation. Oxidizers: <br /> ❑ Installation of Borings/Monitoring Wells. ❑PCB's: <br /> Hazardous Waste Inspection <br /> 3. Specific Site Information: PART III <br /> Tank No.: Tank Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Tank Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:job paint shop ❑Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 5. Release History: ❑Organic Vapor Analyzer. <br /> Evidence of leaks/soil contamination: El YES ❑NO ❑Other,specify. <br /> Documented Groundwater contamination: <br /> ❑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 and Safety Level of Protection: ❑A ❑B ❑C ❑D <br /> Physical Concerns:(check all that apply&describe) ❑Hard Hat. <br /> ❑Hear or Cold Stress: °F(high ambient temp.) C3 Safety Glasses/goggles. <br /> ❑Noise Sources: ❑Steel toed/shank shoes or boots. <br /> C3 Oxygen Deficiency: ElFlame retardant coveralls. <br /> ❑Hearing protection. <br /> C]Excavation:(falls,trips,slipping,cave-ins): ❑Tyvek. <br /> etc ). Respirator:C]Handling and Transfer of a Hazardous Substance:(fire,explosions, ❑ p El APR ❑SCBA <br /> ❑Confined space entry:(explosions): A/P cartridge: <br /> *Jieavy equipment(physical injury&trauma resulting from moving ❑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: Date: <br /> ❑Other/Unknown(specify): y11 <br /> Plan Approved by: A 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(12/17/2002) <br />