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O�µX!~ <br /> ).•'tea•Cpm <br /> ENVI,RCiYENTAL HEALTH I ZP <br /> ARTMENT <br /> SAN JOAQUIN COUNTY <br /> Donna K.Heran,P-t.H.S. Program Coordinators <br /> Director 600 East Main Street, Stockton, California 95202 Kasey L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax. (209)468-3433 Robert McClellon,R.E.H.S. <br /> Web:www.sjgov.org/ehd JeffCamtesco,R.E.H.S. <br /> Linda Turkatte,R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> - RTI AR -- — -- -- - <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> I. Site Name: ^ / 1 1. Chemicals Hazards <br /> Address: Zi7 <br /> ❑Carcinogens: <br /> Contact Person: w;.^ c ��( ;� <br /> ❑Corrosives: <br /> Phone#: Z y <br /> ❑Dusts: <br /> Proposed Date of investigation/insp� tion: ❑Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrative of inspection activity: <br /> ❑Inorganic Gases: <br /> ❑New UST installation UAR Investigation ❑Metals: <br /> ❑Tank Closure in Place [�Tank/Pipe Repair <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal 0'Re-excavation ❑PCBs: <br /> ❑Sampling ❑,Boring/Monitoring Well installation ❑Other: <br /> .Hazardous Waste inspection ❑Tiered Permitting inspection <br /> 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: 7Iank Age: operations unless appropriate rationale or restrictions are provided): <br /> Other: ❑Combustible Gas/Oxygen Meter <br /> ❑Detector Tubes(specify): <br /> 4. Type of Operation: 1 ❑Photo ionization Detector <br /> ❑Organic vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination.; ❑YES ❑NO ❑None(see below) <br /> Documented Groundwater contaminati n: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any ous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health&Safety Physical Con erns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ®D <br /> ❑Heat or Cold Stress: °F "gh ambient temp.) ®Hard Hat <br /> ❑Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots <br /> Excavation(falls,trips,slipping,cav in <br /> ❑Flame retardant coveralls <br /> ,[ 7PH;ndling and Transfer of a Hazardous Substance(fire,explosions,etc.): ®Hearing protection <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical injury& uma resulting from moving A/P Cartridge: <br /> equipment): <br /> ®Safety vest <br /> ❑Other(specify); <br /> ❑Two-way communication <br /> El Other(specify): <br /> 7. Anticipated Biological Hazards: <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants PART IV <br /> ❑Other/Unknown(specify): PLAN APPROVAL <br /> 8. Narrative(provide all information which c uld impact Health and Safety, Plan Prepared <br /> e.g.,power lines,integrity of dikes,terrain etc.): Date: <br /> Plan Approved by:- RJ rL Date: v <br /> I <br /> EH 23081 (12/6/2010) <br /> I <br />