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a ENviRoAENTAL HEALTH D ARTMENT SAN JOAQM COUNTY Program Coordinators Director Donna K. RE.a.s. 600 East Main Street, Stockton,California 95202 Kasey L.Foley,RE.H.S.Telephone:(209)468-3420 Fax Robert McClellon,RE.H.S.(209)468-3433 Jeff Carruesco,RE.H.S. Web:www.sjgov.org/ehd Linda Turkatte,R.H.H.S. SM HEALTH&SAFETY PLAN PART PART II GENERAL SITE INFORMAON EVALUATION OF POTENTIAL HAZARDS 1, Site Name: AU#14 , pri"t- 1. Chemicals Hazards Address: '1715 4&4 010)r SlktV }❑�Carcinogens: Contact Person: 1-1061 On" tp Corrosives: Phone#: Dusts: Proposed Date of investigation/iospection:_ r fZZ-1 11 ❑Explosives: '®Flammrables: 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: ❑New UST installation ❑UAR Investigation ❑Metals: ❑Tank Closure in Place ❑Tank/Pipe Repan ❑Oxidizers: ❑Tank/Pipe Removal ❑Rc- cavation ❑PCBs: ❑Sampling ❑Boring/Monitoring Well installation ❑Other. D5 Hazardous Waste inspection ❑Tiered Permitting inspection PART III 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.: Tank Capacity: I. Monitoring Equipment(Note:Monitoring instruments most be used for all Tank Contmt: Tank Age: operations unless appropriate rationale or restrictions are provided): Other: ❑Combustible Gas/Oxygen Meter ❑Detector Tubes(specify): 4. Type of Operation: ❑Photo ionization Detector ❑Organic Vapor Analyzer 5. Release History: ❑Other(specify): Evidence of leaks/soil contamination: ❑YES ❑NO ❑None(see below) Documented Groundwater contamination: ❑YES ❑NO If monitoring instrmnems are not used,rationale m activity/area restrictions: Background and description of any previous investigation or incidence: 2. Personal Protective Equipment 6. Potential Health&Safely Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ®D ❑Heat or Cold Stress: OF(high ambient temp.) ®Hard Hat ❑Noise Sources: ®Safety Glasses/Goggles ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots ❑Excavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls ❑Handling and Transfer of a Hazardous Substance(fire,explosions,etc.):, ®Hearing protection ❑Tyvek ❑Confined space entry(explosions): ❑Respirator. ❑APR ❑SCBA •Heavy equipment(physical injury&trauma resulting from moving A/P Cartridge: equipment): ®Safety vest ❑Other(specify); ❑Two-way communication ❑Other(specify): 7. Anticipated Biological Hazards: ❑Snakes �Wccts ❑Rodents ❑Poisonous Plants PART IV ❑Other/Unknown(specify): PLAN APPROVAL 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared by: M Naidu Date: 017-11/ e.g.,power lines,integrity of dikes,terrain,etc.): Plan Approved by: 2U r�— Date: EH 23081(5/6/2011)