COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

ENVIRONMENTAL HEALTH DEPARTMENT SAN JOAQUIN COUNTY c Unit Supervisors Donna K.Heron,R.E.H.S. SAN East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. Director Mike Huggins,R.E.H.S.,R.D.I. Al Olsen,R.E.H.S. Stockton, California 95202-2708 Douglas W.Wilson,R.E.H.S. Program Manager Telephone: (209)468-3420 Margaret Lagorio,R.E.H.S. Laurie A.Cotulla,R.E.H.S. Program Manager Fax: (209) 464-0138 Robert McClellon,R.E.H.S. Mark Barcellos,R.E.H.S. SITE HEALTH AND SAFETY PLAN PART I PART H GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS 1. Site Name:Countryside Mini Man L. Chemicals Hazards Address: 14971 N.Hwv 88,Lodi.CA E Carcinogens: Contact Person:Gary Burgin Phone No:(209)268-5380 ❑Corrosives: Sweeps Number: E Dusts: Proposed Date of investigation/inspection:March 7.2005 ❑Explosives: E Flammables: 2. Description and brief narrative of inspection activity: ❑ Inorganic Gases: ❑New UST installation. ❑OAR Investigation. E Metals: ❑Tank Closure in Place. ❑Tank/Pipe Repair. ❑Oxidizers: ❑Tank/Pipc Removal. ❑Re-excavation. ❑PCB's: ❑Installation of Borings/Monitoring Wells. E Hazardous Waste Inspection ❑Sampling. PART III 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.: Tank Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided) Other: ❑Combustible Gas/Oxygen Meter. ❑Detector Tubes(Specify). 4. Type of Operation:Gas Station ❑Photo ionization Detector. ❑Organic Vapor Analyzer. 5. Release History: ❑Other,specify. Evidence of leaks/soil contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: Documented Groundwater contamination: ❑YES ❑NO Background and description of any previous investigation or incidence: 2. Personal Protective Equipment Level of Protection: ❑A ❑B ❑C E D 6. Potential Health and Safety E Hard Hat. ®Safety Glasses/goggles. Physical Concerns:(check all that apply&describe) ®Steel toed/shank shoes or boats. ❑Hear or Cold Stress: °F(high ambient temp.) E Noise Sources: EOUB'MENT ❑Flame retardant coveralls. ❑Oxygen Deficiency: E Hearing protection. ❑Excavation:(falls,trips,slipping,cave-ins): ❑Tyvek. ❑ ❑Handling and Transfer of Hazardous Substance:(fire,explosions, Respirator: [I APR El SCBA etc..): A/P cartridge: ❑Confined space entry:(explosions): E Safety vest. ❑Heavy equipment(physical injury&trauma resulting from moving E Two-way communication. equipment): ❑Other,specify PART IV-PLAN APPROVAL 7. Anticipated Biological Hazards: ��' r r Plan Prepared b l ate: ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants ❑Other/Unknown(specify): Plan Approved by: Date: 8. Narrative(provide all information which could impact Health and Safety, e.g.,power lines,integrity of dikes,terrain,etc.):UNKNOWN EH 23081 (12/17/2002)