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ENVIRONMENTAL HEALTH DEPARTMENT <br /> p4U`" SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Q ?� Donna K.Heran,R.E.H.S. 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> XDirector� Mike Huggins,R.E.H.S.,R.D.I. <br /> AI Olsen,R.E.H.S. Stockton, California 95202-2708 Douglas W.Wilson,R.E.H.S. <br /> • c'OtrFoaN�c • Program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie A.Corolla,R.E.H.S. Robert McClellon,R.E.H.S. <br /> Program Manager Fax: (209) 464-0138 Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PARTI PARTII <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:End of Line Auto Repair 1. Chemicals Hazards <br /> Address:200 Commerce Ct#110.Lodi.CA E Carcinogens: <br /> Contact Person:Pete Salas Phone No:(209)3656077 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:May 17.2005 ❑Explosives: <br /> E Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑ Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. E 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 /> E Hazardous Waste Inspection ❑Sampling. PART 11[ <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 /> operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age: <br /> ❑Combustible Gas/Oxygen Meter. - <br /> Other: <br /> ❑Detector Tubes(Specify). <br /> E]Photo ionization Detector. <br /> 4. Type of Operation:Automotive Repair <br /> ❑Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> 5. Release History: If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Evidence of teaks/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 /> 6. Potential Health and Safety E Hard Hat. <br /> Physical Concerns:(check all that apply&describe) E Safety Glasses/goggles. <br /> [IHear or Cold Stress: °F(high ambient temp.) E Steel toed/shank shoes or boots. <br /> E]Flame retardant coveralls. <br /> E Noise Sources: EOVIPMENT <br /> E Hearing protection. <br /> ❑Oxygen Deficiency: <br /> ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Handling and Transfer of a Hazardous Substance:(tire,explosions, El Respirator: [I APR ❑SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): E Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving E Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: s <br /> Plan Prepared by<�4Z-, g I—� Date: <br /> ❑Snakes El 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.):UNKNOWN <br /> EH 23081 (12/17/2002) <br />