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PA] GEr 1. 2 3. 4 5 6. 7 8. EHE ND SAFETY PLAN PART II EVALUATION OF POTENTIAL HAZARDS I. Chemicals Hazards ® Carcinogens: oil. fuel ® Corrosives: battery acid ❑ Dusts: ❑ Explosives: ®Flammables: oil. fuel ❑ Inorganic Gases: ❑ Metals: ❑ Oxidizers: ❑ PCB's: ❑ Other. PART III REQUIRED PERSONAL PROTECTIVE EQUIPMENT I. Monitoring Equipment (note: Monitoring instruments must be used for all operations unless appropriate rationale or restrictions are provided) ❑ Combustible Gas/Oxygen Meter. ❑ Detector Tubes (Specify). ❑ Photo ionization Detector. ❑ Organic Vapor Analyzer. ❑ Other, specify. If monitoring instruments are not used, rationale or activity / area restrictions: 2. Personal Protective Equipment Level of Protection: ❑ A ❑ B ❑ C ® D ® Hard Hat. ® Safety Glasses/goggles. ® Steel toed/shank shoes or boots. ❑ Flame retardant coveralls. ® Hearing protection. ❑ Tyvek. ❑ Respirator: ❑ APR ❑ SCBA A/P cartridge: ® Safety vest. ❑ Two-way communication. PART IV - PLAN APPROVAL Plan Prepared by: Aris Cacapit Date: February 24 2011 Plan Approved by: Date: SITE HEALTH A LT I ERAL SITE INFORMATION Site Name: Camanche Pumpina Plant Address: 24235 N. Cord Rd. Clements A 95227 Contact Person: Eric of Balfour Bea No: 209 649-5219 Sweeps Number: 2-25-11 Proposed Date of investigation/inspection: Description and brief narrative of ins tion activity: ❑ New UST installation. ❑ UAR Investigation. ❑ Tank Closure in Place. ❑ Tank/Pipe Repair. ❑ Tank/Pipe Removal. ❑ R excavation. ❑ Installation of Borings / Monitoring Wells. ® HW inspection Specific Site Information: Tank No.: Ta nk Capacity: Tank Content: Ta nk Age: Other: Type of Operation: Camanche Pum in Plant Release History: Evidence of leaks / soil contamination: ❑ YES ❑ NO Documented Groundwater contamination: ❑ YES ❑ NO Background and description of any pre ious investigation or incidence: Potential Health and Safety Physical Concerns: (check all that appl & describe) ❑ Heat or Cold Stress: (high ambient temp.) ® Noise Sources: traffic ❑ Oxygen Deficiency: ❑ Excavation: (falls, trips, slipping, cave-ins): ❑ Handling and Transfer of a Hazardous Substance: (fire, explosions, etc..): ❑ Confined space entry: (explosions): trauma resulting from moving ® Heavy equipment (physical injury 4, equipment): Pumping Plant ffluipment ❑ Other, specify Anticipated Biological Hazards: ❑ Snakes ® Insects ❑ Roden ❑ Poisonous Plants ❑ Other/Unknown (specify): Narrative (provide all information which could impact Health and Safety, e.g., power lines, integrity of dikes, ten ain, etc.) 3081(12/17/2002) ND SAFETY PLAN PART II EVALUATION OF POTENTIAL HAZARDS I. Chemicals Hazards ® Carcinogens: oil. fuel ® Corrosives: battery acid ❑ Dusts: ❑ Explosives: ®Flammables: oil. fuel ❑ Inorganic Gases: ❑ Metals: ❑ Oxidizers: ❑ PCB's: ❑ Other. PART III REQUIRED PERSONAL PROTECTIVE EQUIPMENT I. Monitoring Equipment (note: Monitoring instruments must be used for all operations unless appropriate rationale or restrictions are provided) ❑ Combustible Gas/Oxygen Meter. ❑ Detector Tubes (Specify). ❑ Photo ionization Detector. ❑ Organic Vapor Analyzer. ❑ Other, specify. If monitoring instruments are not used, rationale or activity / area restrictions: 2. Personal Protective Equipment Level of Protection: ❑ A ❑ B ❑ C ® D ® Hard Hat. ® Safety Glasses/goggles. ® Steel toed/shank shoes or boots. ❑ Flame retardant coveralls. ® Hearing protection. ❑ Tyvek. ❑ Respirator: ❑ APR ❑ SCBA A/P cartridge: ® Safety vest. ❑ Two-way communication. PART IV - PLAN APPROVAL Plan Prepared by: Aris Cacapit Date: February 24 2011 Plan Approved by: Date: