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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SITE HEALTH AND SAFETY PLAN PART GENERAL SITE INFORMATION PART II 1. Site Name:JM MFG CO INC EVALUATION OF POTENTIAL HAZARDS Address: 1051 Sperry Rd.,Stockton 1. Chemicals Hazards Contact Person:Chuck Clark Phone No:982-1500 ®Carcinogens:Waste Oil,used absorbents Sweeps Number: ❑Corrosives: Proposed Date of investigation/inspection:May 2007 ❑Dusts: ❑Explosives: 2. Description and brief narrative of inspection activity: ❑Flammables: ❑New UST installation.. ❑UAR Investigation. ❑Inorganic Gases: ❑Tank Closure in Place.. ❑Tank/Pipe Repair. ❑Metals: ❑Tank/Pipe Removal. ❑Re-excavation. ❑Oxidizers: ❑Installation of Borings/Monitoring Wells. ❑PCB's: ®Hazardous waste inspection ❑ Sampling ❑Tiered Permitting inspection 3. Specific Site Information: PART III Tank No.: Tank Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank Content: Tank Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all Other. operations unless appropriate rationale or restrictions are provided) ❑Combustible Gas/Oxygen Meter. 4. Type of Operation: MANUFACTURE PVC PIPE ❑Detector Tubes(Specify). ❑ 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 ®D 6. Potential Health and Safety ®Hard Hat. Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. ❑Heat or Cold Stress: °F(high ambient temp.) ®Steel toed/shank shoes or boots. ❑Noise Sources: ❑Flame retardant coveralls. ❑Oxygen Deficiency: ®Hearing protection. ❑Excavation:(falls,trips,slipping,cave-ins): ❑Tyvek. ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, ❑Respirator: ❑APR ❑SCBA etc..): A/P cartridge: ❑Confined space entry:(explosions): El Heavy equipment(physical injury&trauma resulting from moving ®Safety vest. equipment): ❑Two-way communication. ❑Other,specify PART IV-PLAN APPROVAL 7. Anticipated Biological Hazards: ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants Plan Prepared by:Ray von Flue Date:5/11/07 ❑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.) EH 23081(02/19/03)