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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:Sanbom Chevrolet Prolu ie-Shop I. Chemicals Hazards <br /> Address: 1210 S.Cherokee Lane Loi CA 95241 <br /> ®Carcinogens: oil,transmission fluid.coolant <br /> Contact Person:Jerry Curtis No:(209)334-5000 <br /> ®Corrosives:lead acid batteries <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspection: 7 —1 ❑Explosives: <br /> ®Flammables:oil <br /> 2. Description and brief narrative of ins 3ection activity: ❑ inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. ®Metals:oil&fuel filters,metal fines <br /> ❑Tank Closure in Place. ❑ ank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitori ig Wells. ®Other:contaminated absorbent,solvents <br /> ®HW inspection ❑Tiered Permit inspection <br /> 3. Specific Site Information: PART III <br /> Tank No.: Tank Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Tank Age: l. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:car sales and sen ice ❑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: OYES ❑NO ❑Other,specify. <br /> Background and description of any previous investigation or incidence: 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 OD <br /> ®Hazd Hat. <br /> ®Heat or Cold Stress: 95°F(high ambient temp.) <br /> ®Noise Sources:traffic ®Safety Glasses/goggles. <br /> El Oxygen Deficiency: ®Steel toed/shank shoes or boots. <br /> ❑Flame retardant coveralls. <br /> ❑Excavation:(falls,trips,slipping cave-ins): <br /> ®Hearing protection. <br /> ❑Handling and Transfer of a Haza dous Substance:(fire,explosions, <br /> etc..): ElTyvek. <br /> ❑Confined space entry:(explosion;): ❑Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical inju &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 ❑Rodt nts ❑Poisonous Plants <br /> ❑Other/Unknown(specify): <br /> Plan Prepared by:Aris Cacapit Date:7-9-12 <br /> 8. Narrative(provide all information which could impact Health and Safety, ! , _( �L-kq'LV' <br /> e.g.,power lines,integrity of dikes, main,etc.) Plan Approved by: V""' Date: <br /> EH 23081(12/17/2002) <br />