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gUlry ENviRON*ENTAL HEALTH D. .,?ARTMENT SAN JOAQUIN COUNTY program Coordinators Donna K.Heron,R.E.H.S. Director 600 East Main Street, Stockton,California 95202 Kas ey L.Foley,RE.H.S. Telephone:(209)468-3420 Fax:(209)468-3433 Robert McClellon,R.E.H.S. Jeff Carruesco,R.E.H.S. Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. SITE HEALTH& SAFETY PLAN PARTI PART II GENERAL SITE INFORMATION ,,ff , EVALUATION OF POTENTIAL HAZARDS 1. Site Name: C pm'4 r-4--c r 0_*DY}"�__ 1. Chemicals Hazards Address: O r �,t�Carcinogens: Contact Person: O LY Corrosives: y aic* Phone#: `L V-Z —lq2,o x ❑Dusts: Proposed Date of invenigation/inspectiom i 0/26P'— J0 3 1= ❑Explosives: Flammables: 0l7/kJ10,�„r,/19�0�P.(�F'Dgdl10� 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: ❑New UST installation ❑UAR Investigation Wdetalsmim1 OA4um ❑Tank Closure in Place ❑Tank/Pipe Repair KOxidiz a&VAA% ❑Tank/Pipe Removal ❑Re-excavation ❑PCBs �1 ❑Sampling ❑Homing/Monitoring Well installation lr'f Other{(C'JI.�(tx(R.� (1711A��,ravt U MpM Or(ill'Pr, C•2t�ni V.M OC:[/aL7 Hazardous Waste inspection ❑Tiered Permitting inspection ��/p mkk4w {�yd'Wu f�r W1�GL4f.t)O(OX/G[tcJ / t PART IIIc� loilt � rP0y� i 3. Specific Site Information: REQUIRED PE S NAL PROTE 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 Operatioh: . ❑Photo ionization Detector ❑Organic Vapor Analyzer 5. Release History: ❑Other(specify)' Evidence of leaks/soil contamination: ❑YES ❑NO 'A None(see below) Documented Groundwater contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: Background and description of any previous investigation or incidence: 2. Personal Protective Equipment 6. Potential Health&Safety Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ED ❑Heat or Cold Stress: OF(high ambient temp.) E Hard Hat ❑Noise Sources: ®Safety Glasses/Goggles ® El Oxygen Deficiency: Steel toed/shank shoes or boots ��k��...�```xcavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls dling and Transfer of a Hazardous Substance(fire,explosions,etc.); E Hearing protection ❑Tyvek ❑Confined space entry(explosions): ❑Respirator. ❑APR ❑SCBA Heavy equipment(physical injury&trauma resulting from moving A/P Cartridge: equipment): �E Safety vest ❑Other(specify): X Two-way communicatiolf;kJoYLe— ❑Other(specify): 7. Anticipated Biological Hazards: Snakes �tsects .dems ❑Poisonous Plants PART IV ❑Other/Unknown(specify): PLAN APPROVAL 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared b ' Date:/O e.g.,power lines,integrity of dikes,terrain,etc.):. , / .` 1 6 Plan Approved byv: Date: v ✓V EH 23081(3/52012)