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PART I <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />Pp U N <br />SAN JOAQUIN COUNTY <br />1. Site Name: Tracy Power Equipment <br />"Director <br />Donna K. Heran, RE.H.S. <br />304 East Weber Avenue, Third Floor <br />Unit Supervisors <br />Carl Borgtnan, R.E.H.S. <br />• • <br />J% <br />Al Olsen, R.E.H.S. Stockton California 95202-2708 <br />Mike Huggins, R.E.H.S., R.D.I. <br />c��P <br />Program Manager Telephone: 209 468-3420 <br />Il ( ) <br />Douglas W. Wilson, R.E.H.S. <br />Margaret Lagorio, R.E.H.S. <br />oa <br />Laurie A. Cotulla, R.E.H.S. <br />Program Manager Fax: (209) 464-0138 <br />Robert McClellon, R.E.H.S. <br />❑ Inorganic Gases: <br />SITE HEALTH AND SAFETY PLAN <br />Mark Barcellos, R.E.H.S. <br />PART I <br />PART II <br />GENERAL SITE INFORMATION <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Site Name: Tracy Power Equipment <br />1. Chemicals Hazards <br />Address: 7575 Carmelo Avenue, Tracy. CA <br />®Carcinogens: <br />Contact Person: Wade Bok Phone No: (209) 833-1000 <br />❑ Corrosives: <br />Sweeps Number: <br />® Dusts: <br />Proposed Date of investigation/inspection: May 12, 2005 <br />❑ Explosives: <br />® Flammables: <br />2. Description and brief narrative of inspection activity: <br />❑ Inorganic Gases: <br />❑ New UST installation. ❑ UAR Investigation. <br />® Metals: <br />❑ Tank Closure in Place. ❑ Tank/Pipe Repair. <br />❑ Oxidizers: <br />❑ Tank/Pipe Removal. ❑ Re -excavation. <br />❑ PCB's: <br />❑ Installation of Borings / Monitoring Wells. <br />® Hazardous Waste Inspection ❑ Sampling. <br />PART III <br />3. Specific Site Information: <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />Tank No.: Tank Capacity: <br />1. 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 />❑ Combustible Gas/Oxygen Meter. <br />Other: <br />❑ Detector Tubes (Specify). <br />❑ Photo ionization Detector. <br />4. Type of Operation: Power equipment maintenance <br />❑ Organic Vapor Analyzer. <br />El Other, specify. <br />5. Release History: <br />If monitoring instruments are not used, rationale or activity / area restrictions: <br />Evidence of leaks /soil contamination: YES F-1 NO <br />❑ <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 />® Safety Glasses/goggles. <br />Physical Concerns: (check all that apply &describe) <br />® Steel toed shank shoes or boots. <br />❑ Hear or Cold Stress: °F (high ambient temp.) <br />ElFlame retardant coveralls. <br />® Noise Sources: EOUII'MENT <br />® Hearing protection. <br />El Oxygen Deficiency: <br />❑ Tyvek. <br />E] Excavation: (falls, trips, slipping, cave-ins): <br />E] Respirator: APR ❑ SCBA <br />E] Handling and Transfer of a Hazardous Substance: (fire, explosions, <br />A/P cartridge: <br />etc..): <br />❑ Confined space entry: (explosions): <br />® Safety vest. <br />❑ Heavy equipment (physical injury & trauma resulting from moving <br />® Two-way communication. <br />equipment): <br />❑ Other, specify <br />PART IV - PLAN APPROVAL <br />7. Anticipated Biological Hazards: <br />,( <br />t 6s� <br />Plan Prepared b• Date: <br />E3 Snakes ❑ Insects El Rodents ❑ Poisonous Plants <br />❑ Other/Unknown (specify): <br />% <br />Plan Approved by: CiC� 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 />