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w s°¢A�,Ea Foal <br /> < ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY Program Coordinators <br /> Donna K.Heran,R.E.H.S. 1868 E. Hazelton Ave. Stockton California 95205 Kasey L.Foley,R.E.H.S. <br /> Director Robert McClellon,R.E.H.S. <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Jeff Carruesco,R.E.H.S. <br /> Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. <br /> Rodney Estrada,R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN Adrienne Ellsaesser,R.E.H.S. <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: — 7 L Chemicals Hazards <br /> Address: Z7a- O /!J/JA2 rM 'XCarcinogen ^ -/•. <br /> Contact Person: . /7PQ i21/! ❑Corrosives: <br /> Phone N: ❑Dusts: <br /> Proposed Date of investigation/inspection: a ❑Explosives: <br /> '�ZFlammables' 4_4 QA O /2 0 <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation ❑UAR Investigation ❑Metals: <br /> ❑Tank Closure in Place ❑Tank/Pipe Repair ❑Oxidizers: <br /> ❑Tank/Pipe Removal ❑Re-excavation ❑PCBs: <br /> ❑Sampling ❑Boring(Monitoring Well installation ❑Other: <br /> Hazardous Waste inspection ❑Tiered Permitting inspection <br /> `Hazardous Materials Business Plan PART III <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 3. Specific Site Information: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all <br /> Tank No.: Tank Capacity: operations unless appropriate rationale or restrictions are provided): <br /> Tank Content: Tank Age: ❑Combustible Gas/Oxygen Meter <br /> Other ❑Detector Tubes(specify): <br /> ��JJ��,,yy,� <br /> L]Photo ionization Detector <br /> 4. Type of Operation: �1Q�6Cjf�L� ❑Organic Vapor Analyzer <br /> ❑Other(specify): <br /> 5. Release History: NLNone(see below) <br /> Evidence of leaks/soil contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <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 <br /> 6. Potential Health&Safety Physical Concerns:(check all that apply& ❑Hard Hat <br /> describe) ❑Safety Glasses/Goggles <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ❑Steel toed/shank shoes or boots <br /> ❑Noise Sources: ❑Flame retardant coveralls <br /> ❑Oxygen Deficiency: ❑Hearing protection <br /> ❑Excavation(falls,trips,slipping,cave-ins): ❑Tyvek <br /> �YlFlmdling and Transfer of a Hazardous Substance(fire,explosions,etc.).. El Respirator: El APR ElSCBA <br /> 7]�V A/P Cartridge: <br /> ❑Confined space entry(explosions): ❑Safety vest <br /> Meavy equipment(physical injury&trauma resulting from moving ❑Two-way communication <br /> equipment): ❑Other(specify): <br /> ❑Other(specify): <br /> PART IV <br /> 7. Anticipated Biological Hazards: PLAN APPROVAL <br /> ❑Snakes Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Prepared ° - Date: 9 S <br /> 8. Narrative(provide all information which could impact Health and Safety, plan Approved by: Date: I C <br /> e.g.,power lines,integrity of dikes,terrain,rim): <br /> EH 23081(1/22013) <br />