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PA: GET 1. 2. 3 4. 5. 6. 7 8 EH 2 ND SAFETY PLAN PART II EVALUATION OF POTENTIAL HAZARDS 1. Chemicals Hazards ® Carcinogens: oil ❑ Corrosives: ❑ Dusts: ❑ Explosives: ®Flammables: gasoline, oxygen ❑ Inorganic Gases: ❑ Metals: ❑ Oxidizers: ❑ PCB's: ❑ Other: PART III REQUIRED PERSONAL PROTECTIVE EQUIPMENT 1. 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 Ca�capiitjt Date: April 29, 2010 Plan Approved by: V►4" Date: (;-1, 1,0 SITE HEALTH IT I IERAL SITE INFORMATION Site Name: Camanche Pumping Plant alfour Beatty Infrastructure Address: 24235 N Cord Rd. Clements A 95227 Contact Person: Bill Clark Phone No: 707 427-8900 Sweeps Number: n: Proposed Date of investigation/inspecti Description and brief narrative of inspec bon activity: ❑ New UST installation. ❑ UA R Investigation. ❑ Tank Closure in Place. ❑ Tank/Pipe Repair. ❑ Tank/Pipe Removal. ❑ Re excavation. ❑ Installation of Borings / Monitoring ® HW inspection ells. Specific Site Information: Tank No.: Tar k Capacity: Tank Content: Tar k Age: Other: Type of Operation: water pu!nping static Release History: Evidence of leaks / soil contamination: ❑ YES ❑ NO Documented Groundwater contamination: ❑ YES ❑ NO Background and description of any previ DUS investigation or incidence: Potential Health and Safety Physical Concerns: (check all that apply, describe) ❑ Heat or Cold Stress: °F(high ambient temp.) ® Noise Sources: traffic ❑ Oxygen Deficiency: -ins): ❑ Excavation: (falls, trips, slipping, cav Substance: (fire, explosions, ❑ Handling and Transfer of a Hazardous etc..): ❑ Confined space entry: (explosions): uma resulting from moving ® Heavy equipment (physical injury & equipment):water Rumps ❑ Other, specify Anticipated Biological Hazards: ❑ Snakes ® Insects ❑ Rodents ❑ Poisonous Plants ❑ Other/Unknown (specify): Narrative (provide all information which e.g., power lines, integrity of dikes, terrai ould impact Health and Safety, i, etc.) 3081 (12/17/2002) ND SAFETY PLAN PART II EVALUATION OF POTENTIAL HAZARDS 1. Chemicals Hazards ® Carcinogens: oil ❑ Corrosives: ❑ Dusts: ❑ Explosives: ®Flammables: gasoline, oxygen ❑ Inorganic Gases: ❑ Metals: ❑ Oxidizers: ❑ PCB's: ❑ Other: PART III REQUIRED PERSONAL PROTECTIVE EQUIPMENT 1. 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 Ca�capiitjt Date: April 29, 2010 Plan Approved by: V►4" Date: (;-1, 1,0