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ENVIRONMENTAL HEALTH DEPARTMENT <br /> °P�.�`N. ° SAN JOAQUIN COUNTY <br /> �. <br /> Q � ?� 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 /> ".�;P Program Manager Telephone: (209) 468-3420 Douglas W.Wilson,R.E.H.S. <br /> q F o a Laurie A.Cotulla,R.E.H.S. Margaret Lagorio,R.E.H.S. <br /> Fax: (209)464-0138 Robert McClellon,R.E.H.S. <br /> Program Manager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Holt of California 1. Chemicals Hazards <br /> Address: 1521 W.Charter Way,CA 95206 <br /> ®Carcinogens: <br /> Contact Person:Don Lloyd Phone No:(209)466-6000 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:May 25,2005 ❑Explosives: <br /> ®Flammables: <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 /> E Hazardous Waste Inspection ❑Sampling. PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity:_ l. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age _ _ <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> F-1 Photo ionization Detector. <br /> 4. Type of Operation:Maintenance/Repair <br /> ❑Organic Vapor Analyzer. <br /> ❑ <br /> 5. Release History: Other,specify. <br /> Evidence of leaks/soil contamination: [I YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contamination: ❑YES ❑NO <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C ®D <br /> ®Hard Hat. <br /> 6. Potential Health and Safety <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ®Steel toed/shank shoes or boots. <br /> ❑Hear or Cold Stress: °F(high ambient temp.) <br /> El Flame retardant coveralls. <br /> ®Noise Sources: EQUIPMENT <br /> ®Hearing protection. <br /> ❑Oxygen Deficiency: <br /> ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Respirator: [I APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, A/P cartridge: <br /> etc..): <br /> F1 Confined space entry:(explosions): ®Safety vest. <br /> El Heavy equipment(physical injury&trauma resulting from moving ®Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by: r ag�Zate: <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by: Date: <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.):UNKNOWN <br /> EH 23081(12/17/2002) <br />