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SAN PART I GENERAL SITE INFORMATION 1. Site Name: Bambu's Engine and 7 Address: 1031 E. Church St., Stoc Contact Person: Bimal Maharaj_ Sweeps Number: Proposed Date of investigation/ins 2. Description and brief narrative of ins ❑ New UST installation.. ❑ ❑ Tank Closure in Place.. ❑ ❑ Tank/Pipe Removal. ❑ ❑ Installation of Borings / Monitori ® Hazardous waste inspection ❑ ❑ Tiered Permitting inspection 3. Specific Site Information: Tank No.: Tank Content: Other: 4. Type of Operation: Engine and 5. Release History: Evidence of leaks / soil contamination: Documented Groundwater contaminati Background and description of any pre COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SITE HEALTH AND SAFETY PLAN Phone No: 463-9046 )n: May 27, 2008 ;tion activity: \R Investigation. nk/Pipe Repair. ;-excavation. Wells. unpling nk Capacity: nk Age: ssion rebuilding ❑ YES ❑ NO n: ❑ YES ❑ NO sous investigation or incidence: 6. Potential Health and Safety Physical Concerns: (check all that appl ❑ Heat or Cold Stress: °F ❑ Noise Sources: ❑ Oxygen Deficiency: ❑ Excavation: (falls, trips, slipping, cav ❑ Handling and Transfer of a Hazardot etc--)-- ❑ Confined space entry: (explosions): - El Heavy equipment (physical injury & equipment): ❑ Other, specify 7. Anticipated Biological Hazards: ❑ Snakes ❑ Insects ❑ Rodents ❑ Other/Unknown (specify): 8. Narrative (provide all information v e.g., power lines, integrity of dikes, EH 23081 (02/19/03) describe) ;h ambient temp.) Substance: (fire, explosions, resulting from moving ❑ Poisonous Plants uld impact Health and Safety, etc.) PART II EVALUATION OF POTENTIAL HAZARDS 1. Chemicals Hazards ® Carcinogens: waste oil, used absorbents ❑ Corrosives: ❑ Dusts: ❑ Explosives: ❑ Flammables: ❑ Inorganic Gases: ❑ Metals: ❑ Oxidizers: ❑ PCB's: 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: Ray von Flue Date: 5/27/08 Plan Approved by: Date: