Laserfiche WebLink
SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Gregg Property Service 1. Chemicals Hazards <br /> Address:401 N.California St.Lodi,CA 95240 <br /> ®Carcinogens: oil.solvents <br /> Contact Person:Kenneth Gregg No:(209)334-4227 ❑Corrosives: <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspection: -tf ❑Explosives: <br /> ®Flammables:oil, <br /> 2. Description and brief narrative of inspection activity: <br /> ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. <br /> ❑Metals:lead,arsenic,cadmium <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. ®Other:contaminated absorbent,halogens,organics <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: 1. 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 /> A <br /> 4. Type of Operation:dacleaning and laundry service/ 4 avv?�. C]Detector Tubes(Specify). <br /> 5. Release History: ❑Photo ionization Detector. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑Organic Vapor Analyzer. <br /> ❑ <br /> Documented Groundwater contamination: E]YES [I 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 /> 2• Personal Protective Equipment <br /> 6. Potential Health and Safety <br /> Level of Protection: El A El B ❑C OD <br /> Physical Concerns:(check all that apply&describe) <br /> ®Hard Hat. <br /> ®Heat or Cold Stress: 95°F(high ambient temp.) <br /> ®Safety Glasses/goggles. <br /> ®Noise Sources:traffic. <br /> ❑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 Hazardous Substance:(fire,explosions, <br /> etc..): ElTyvek. <br /> ❑Confined space entry:(explosions): El Respirator: F1 APR El 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 /��,,,(�y� <br /> ❑Other/Unknown(specify): Plan Prepared by: / (�^F%1V1L�I Date: <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Approved by: Date: C1 <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(12/17/2002) <br />