Laserfiche WebLink
O.p4UIN' C <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> a;P.• SAN JOAQUIN COUNTY Program Coordinators <br /> . 1.0 Donna K.Heran,R.E.H S. <br /> 1868 E. Hazelton Ave.,Stockton,California 95205 Kaley L.Foley,R.E.H.S. <br /> Director Robert McClellon,R.E.H.S. <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Jeff Carruesco,R.E.H.S. <br /> Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. <br /> SITE HEALTH&SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: ParkwoodS Cleaners 1. Chemicals Hazards <br /> Address: 1901 Country Club, Stockton ❑Carcinogens: <br /> Contact Person:Jeff Kitto ❑Corrosives: <br /> Phone 4: 464-2181 ❑Dusts: <br /> Proposed Date of investigation/ins tion:Nov 29, 2012 ❑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 ❑ Ze-excavation ❑PCBs: <br /> ❑Sampling ❑Boring/Monitoring Well installation ❑Other: <br /> ®Hazardous Waste inspection ❑Tiered Permitting inspection <br /> ❑Hazardous Materials Business Pl Ln PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all <br /> Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided): <br /> Other: ❑Combustible Gas/Oxygen Meter <br /> ❑Detector Tubes(specify): <br /> 4. Type of Operation:Dry Cleaner - non PERC ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contaminatio : ❑YES ❑NO ❑None(see below) <br /> Documented Groundwater contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any revious investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health&Safety Physical oncems:(check all that apply& Level of Protection: ❑A ❑B ❑C ®D <br /> describe) ®Hard Hat <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Safety Glasses/Goggles <br /> ❑Noise Sources: ®Steel toed/shank shoes or boots <br /> ❑Oxygen Deficiency: ❑Flame retardant coveralls <br /> ❑Excavation(falls,trips,slipping cave-ins): ®Hearing protection <br /> ❑ Handling and Transfer of a Ham Lrdous Substance(fire,explosions,etc.):. ❑Tyvek <br /> ®Respirator: ®APR ❑SCBA <br /> ❑Confined space entry(explosio s): A/P Cartridge: <br /> M Heavy equipment(physical injury&trauma resulting from moving ®Safety vest <br /> equipment): ®Two-way communication <br /> ❑Other(specify): ❑Other(specify): <br /> 7: Anticipated Biological Hazards: PART IV <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants PLAN APPROVAL <br /> ❑Other/Unknown(specify): <br /> Plan Prepared by: Garrett Backus Date: Nov 29,2012 <br /> 8. Narrative(provide all information Nhich could impact Health and Safety, /L <br /> e.g.,power lines,integrity of dikes terrain,etc.): I , /l <br /> Plan Approved by: v 1 Date: � �v <br /> EH 23081(8/21/2012) <br />