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SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Custom Metal Finishing 1. Chemicals Hazards <br /> Address: 1550 Shaw Rd C.Stockton fi4-Carcinogens: chromic acid,nickel sulfate(skin irritant) <br /> Contact Person:Neil Davis rh; / Phone N,:463581 I Corrosives:caustic soda(aka sodium hydroxide),sulfuric acid <br /> Sweeps Number. pri Dusts: <br /> Proposed Date of investigation/inspection: 1 DO l❑'Explosives: <br /> �.Flammables: <br /> 2. Description and brief narrative of inspection activity: 5jJnorganic Cases:copper cyanide(when heated toxic fumes) <br /> ❑New UST installation. ❑UAR Investigation. ❑ Metals: <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. Oxidizers:chromic acid <br /> ❑Tank/Pipe Removal. ❑Re-excavation. 19 <br /> El PCB's: <br /> ❑ Installation of Borings/Monitoring Wells. <br /> Hazardous Waste <br /> 3. Specific Site Information: PART III <br /> Tank No.: Tank Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Tank Age: I. Monitoring Equipment(note:Monitoring instruments most be used for all <br /> Othec. operations unless appropriate rationale or restrictions arc provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:Chrome plating&metal finishing ❑Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 5. Release History: ❑Organic Vapor Analyzer. <br /> ,dINO ❑Other,specify. <br /> Evidence of leaks/soil contamination: C1 YES r]' <br /> Documented Groundwater contamination: <br /> ❑YES (XNO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any revious investigation or inci ce: <br /> X > R e�A ler►e <br /> '�G L <br /> 2. Personal Protective Equipment <br /> 6. Potential Health and Safety Level of Protection: ❑A ❑B ❑C <br /> Physical Concerns:(check all that apply&describe) ❑Hard Hat. <br /> ❑Hear or Cold Stress: °F(high ambient temp.) ®-Safety Glasses/goggles. <br /> 3(eel toed/shank shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: <br /> ❑Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Tyvek. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> ❑Respirator: El <br /> arc..): <br /> ❑Confined space entry:(explosions): A/P cartridge: <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ❑Safety vest. <br /> equipment): E]Two-way communication. <br /> Ether,specify �CAL0. <br /> PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: 4 <br /> ❑ hakes [Ibisects ❑Rodents Poisonous Plants Plan Prepared by: Date: <br /> C�J <br /> Cer/Unknown(specify): VI'e-CA0�cS <br /> Plan Approved by: V Date: Q <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity ofdikes,terrain,etc.) <br /> EH 23081(12/17/2002) <br />