COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

PgUfN Z ENVIRONPIENTAL HEALTH DOPARTMENT �9�fFbR�`P Donna K.Heran,R.E.H.S. SAN JOAQUIN COUNTY Program Coordinators Director 600 East Main Street, Stockton,California 95202 Kasey 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 PART I PART IR GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS 1. Site Name: 1. Chemicals Hazards Address: �arcinogens7 - � Contact Perso : /❑Corrosives: Phone#: �OJr—"— �� ❑Dusts: Proposed Date of investigation/inspect i n: ❑Explosives: IF Flammables:69Q'-6p4/h,-, 2. Description and brief narrative of inspection activity: ❑inorganic Gases: ❑New UST installation ❑Uj a Investigation ❑Metals: ❑Tank Closure in Place ❑Tank/Pipe Repair ❑Oxidizers: ❑Tank/Pipe Removal ❑R -excavation ❑PCBs: ❑Sampling ❑B ring/Monitoring Well installation ❑Other: Hazardous Waste inspection ❑Ti Yed Permitting inspection PART III 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.: Ta rik Capacity: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all Tank Content: Ta rik Age: operations unless appropriate rationale or restrictions are provided): Other: ❑Combustible Gas/Oxygen Meter ❑Detector Tubes(specify): 4. Type of Operation: ❑Photo ionization Detector ❑Organic Vapor Analyzer 5. Release History: ❑Other(specify): Evidence of leaks/soil contamination: ❑YES ❑NO '`{None(see below) Documented Groundwater contaminati : ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: Background and description of any preN sous investigation or incidence: 2. Personal Protective Equipment 6. Potential Health&Safety Physical Con crns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ND ❑Heat or Cold Stress: IF I high ambient temp.) ®Hard Hat ❑Noise Sources: N Safety Glasses/Goggles ❑Oxygen Deficiency: N Steel toed/shank shoes or boots xcavation(falls,trips,slipping,ca ins): ❑Flame retardant coveralls Iandling and Transfer of a Hazardo Substance(fire,explosions,etc.):. ®Hearing protection ❑Tyvek ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA Meavy equipment(p is 1 injgry trauma resulting from moving A/P Cartridge: equipment): N Safety vest ❑Other(specify): 0-,Zvo-way communication �h — ❑Other(specify): 7. Anticipated Biological Hazards: ❑Snakes Insects ❑Rodents ❑Poisonous Plants PART IV ❑Other/Unknown(specify): PLAN APPROVAL 8. Narrative(provide all information whicl i could impact Health and Safety, Plan Prepared b . Date: e.g.,power lines,integrity of dikes,terr,in,etc.): w� Plan Approved by: 1 Date: I EH 23081(3/5/2012)