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1 y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ° SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Donna K. Heran, R.E.H.S. p <br /> W :< 304 East Weber Avenue , Third Floor Carl Borgman, R.E.H. S . <br /> Director Mike Huggins, R.E.H. S . , R.D.I. <br /> • Al Olsen, R.E.H.S. Stockton, California 95202-2708 Douglas W. Wilson, R.E.H.S . <br /> cq C� F o R� 4 Program Manager Telephone :( 209) 468 -3420 Margaret Lagorio, R.E .H. S . <br /> Laurie A. Cotulla, R.E.H.S. <br /> Program Manager Fax , (209) 464-0138 Robert McClellon, R.E.H. S . <br /> Mark Barcellos, R.E.H. S .. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1 . Site Name: Costa Automotive 1 . Chemicals Hazards <br /> Address : 408 E. 11TH STREET, TRACY, CA 95376 <br /> ❑ Carcinogens: <br /> Contact Person : Rav Farpella Phone No: (209) 835-3068 ❑ Corrosives : <br /> Sweeps Number: <br /> ® Dusts: <br /> Proposed Date of investigation/inspection: MAY 23 , 3003 ❑ Explosives: <br /> ® Flammables : <br /> 2 . Description and brief narrative of inspection activity: ❑ Inorganic Gases: <br /> ❑ New UST installation . ❑ UAR Investigation. ❑ Metals : <br /> ❑ Tank Closure in Place. ❑ Tank/Pipe Repair. ❑ Oxidizers: <br /> ❑ Tank/Pipe Removal. ❑ Re-excavation. ❑ PCB 's : <br /> ❑ Installation of Borings / Monitoring Wells. <br /> ® Hazardous Waste Inspection ❑ Sampling. 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:_ Tank Age: operations unless appropriate rationale or restrictions are provided) <br /> _ <br /> Other: ❑ Combustible Gas/Oxygen Meter. <br /> -- ❑ Detector Tubes (Specify). <br /> 4. Type of Operation: AUTO & TIRE REPAIR ❑ Photo ionization Detector. <br /> ❑ Organic Vapor Analyzer. <br /> 5 . Release History: El Other, specify. <br /> Evidence of leaks / soil contamination: El YES ❑ NO If monitoring instruments are not used, rationale or activity / area restrictions: <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 /> 6. Potential Health and Safety ® Hard Hat. <br /> Physical Concerns : (check all that apply & describe) ® Safety Glasses/goggles. <br /> ❑ Hear or Cold Stress: °F (high ambient temp.) El Steel toed/shank shoes or boots. <br /> ❑ Noise Sources: ❑ Flame retardant coveralls. <br /> ® Hearing protection. <br /> El Oxygen Deficiency: <br /> E] Excavation : (falls, trips, slipping, cave-ins): El Tyvek. <br /> ❑ <br /> ❑ Handling and Transfer of a Hazardous Substance: (fire, explosions, El Respirator: APR El SCBA <br /> etc. .): A/P cartridge: <br /> ❑ Confined space entry: (explosions): ® Safety vest. <br /> ❑ Heavy equipment (physical injury & trauma resulting from moving ® Two-way communication. <br /> equipment): <br /> ❑ Other, specify PART IV - PLAN APPROVAL <br /> 7. Anticipated Biological Hazards : <br /> Plan Prepared by: CS ate : 2� D <br /> [3 Snakes El Insects El Rodents El Poisonous Plants <br /> ❑ Other/Unknown (specify): Plan Approved by: 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 />