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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:Melendres Auto Body&Paint 1. Chemicals Hazards <br /> Address: 17285 N Bruella Rd.Victor,CA 95253 <br /> ®Carcinogens: paints.solvents <br /> Contact Person:Jose or Erick Melendres No:(209)570-3420 ❑Corrosives: <br /> Sweeps Number: ®Dusts:dusts generated from sanding operations <br /> Proposed Date of investigation/inspection: 6 ?— ❑Explosives: <br /> ®Flammables:paint products.aerosols <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. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®HW inspection El Tiered Permit inspection ®Other:contaminated absorbent solvents <br /> 3. Specific Site Information: PART III <br /> Tank No.: Tank Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Tank Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: <br /> operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:auto body&paint shop ❑Detector Tubes(Specify). <br /> 5. Release History: ❑Photo ionization Detector. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑Organic Vapor Analyzer. <br /> Documented Groundwater contamination: ❑YES ❑NO ❑Other,specify. <br /> Background and description of any previous investigation or incidence: <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> 6. Potential Health and Safety 2. Personal Protective Equipment <br /> Physical Concerns:(check all that apply&describe) Level of Protection: ❑A ❑B ❑C ®D <br /> ®Heat or Cold Stress: 80°F(high ambient temp.) ®Hard Hat. <br /> ®Noise Sources:traffic. ®Safety Glasses/goggles. <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots. <br /> ElExcavation:(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls. <br /> ElHandling and Transfer of a Hazardous Substance:(fire,explosions, ®Hearing protection. <br /> etc..): ❑Tyvek. <br /> ❑Confined space entry:(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical injury&trauma resulting from moving A/P cartridge: <br /> equipment): ®Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes ®Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): <br /> Plan Prepared by:Aris Cacapit Date:6-24-13 <br /> 8. Narrative(provide all information which could impact Health and Safety, �i (0 76 <br /> e.g.,power lines,integrity of dikes,terrain,etc.) Plan Approved by: 1 Date: �+ <br /> EH 23081(12/17/2002) <br />