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0 <br />ENVIR01 MENTAL HEALTiMEPARTMENT <br />SAN JOAQUIN COUNTY <br />Donna K. Heran, R.E.H.S. Unit Supervisors <br />Director 304 East Weber Avenue, Third Floor Carl Borgman, R.E.H.S. <br />Al Olsen, R.E.H.S. Stockton, California 95202-2708 Mike Huggins, R.E.H.S., R.D.I. <br />• c ..' • Pro Douglas W. Wilson, R.E.H.S. <br />Program Manager <br />4��FORa` g g Telephone: (209) 468-3420 Margaret Lagorio, R.E.H.S. <br />Laurie A. Cotulla, R.E.H.S. <br />Program Manager Fax: (209) 464-0138 Robert McClellon, R.E.H.S. <br />SITE HEALTH AND SAFETY PLAN Mark Barcellos, R.E.H.S. <br />PARTI PARTII <br />GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br />1. Site Name: 6;e> tit <br />1. Chemicals Hazards <br />Address: 23i2r w . "^FzxE(Z_ <br />❑ Carcinogens: <br />Contact Person: Phone No: 209 -%:b t- D4910 <br />❑ Corrosives: <br />Sweeps Number: <br />Dusts: <br />Proposed Date of investigation/inspection: dS-2rro,(, <br />❑ Explosives: <br />Flammables: <br />2. Description and brief narrative of inspection activity: <br />❑ New UST installation.ElInorganic Gases: <br />❑ UAR Investigation. <br />ElTank Closure in Place. ❑ Tank/Pipe Repair. 10 Metals: <br />El Tank/Pipe Removal. El Re -excavation. El Oxidizers: <br />❑ Installation of Borings / Monitoring Wells. El PCB's: <br />iiw t NGF'�GTtG1J <br />3. Specific Site Information: PART III <br />Tank No.: Tank Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />Tank Content: Tank Age: <br />Other: <br />4. Type of Operation: AXyW-VrV6 LrM►�UFfiC�yR6fZ <br />5. Release History: <br />Evidence of leaks / soil contamination: ❑ YES ❑ NO <br />Documented Groundwater contamination: ❑ YES ❑ NO <br />Background and description of any previous investigation or incidence: <br />6. Potential Health and Safety <br />Physical Concerns: (check all that apply & describe) <br />❑ Hear or Cold Stress: °F (high ambient temp.) <br />Noise Sources: <br />❑ Oxygen Deficiency: <br />❑ Excavation: (falls, trips, slipping, cave-ins): <br />❑ Handling and Transfer of a Hazardous Substance: (fire, explosions, <br />etc..): <br />❑ Confined space entry: (explosions): <br />Heavy equipment (physical injury & trauma resulting from moving <br />equipment): <br />❑ Other, specify <br />Anticipated Biological Hazards: <br />❑ Snakes ❑ Insects ❑ Rodents <br />❑ Other/Unknown (specify): <br />❑ Poisonous Plants <br />8. Irrative (provide all information which could impact Health and Safety, <br />e.g., power lines, integrity of dikes, terrain, etc.) <br />I. Monitoring Equipment (note: Monitoring instruments must be used for all <br />operations unless appropriate rationale or restrictions are provided) <br />❑ Combustible Gas/Oxygen Meter. <br />❑ Detector Tubes (Specify). <br />❑ Photo ionization Detector. <br />❑ Organic Vapor Analyzer. <br />❑ Other, specify. <br />If monitoring instruments are not used, rationale or activity / area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B ❑ C <br />Hard Hat. <br />Safety Glasses/goggles. <br />/Steel toed/shank shoes or boots. <br />❑ Flame retardant coveralls. <br />Hearing protection. <br />❑ Tyvek. <br />❑ Respirator: ❑ APR ❑ SCBA <br />A/P cartridge: <br />❑ Safety vest. <br />❑ Two-way communication. <br />PART IV - PLAN APPROVAL <br />■ [i <br />Plan Prepared by: LW4 Wu,S Date: tg-25-00 <br />Plan Approved by: Date: <br />