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ENV :tor ONMENTAL HEALTH DEPARTMENT <br /> °P SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> a a, ,�, Donna K.HR.E.H.S. <br /> Dir304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> < .E.H.S. Stockton California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> • Olsen, Douglas W.Wilson,R.E.H.S. <br /> Program i lanager Telephone: (209)468-3420 Margaret Lagorio,R.E.H.S. <br /> F o a <br /> Laurie A.Coti Ila,R.E.H.S. <br /> Program fanager Fax: (209)464-0138 Robert McClellon,R.E.H.S. <br /> ellos <br /> SITE HEALTH AND SAFETY PLAN Car[DINIAL <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:DIVINEY TRUNSPORTATION SERVICES 1. Chemicals Hazards <br /> Address:5161 W.l 1Te ST 4ET,T CY <br /> ®Carcinogens: <br /> Contact Person:DAN DIV EY Phone No:(209)832-6181 ®Corrosives: <br /> Sweeps Number: <br /> ®Dusts: <br /> Proposed Date of investiga'on/inspec on: ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narra ive of insIN ction activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑LAR Investigation. <br /> ®Metals: <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑ -excavation. ❑PCB's: <br /> ®Hazardous Waste Gene utor Inspec ion.. <br /> 3. Specific Site Information: PART III <br /> Tank No.: T ink Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: T ink Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:TRUCK&TRAILER SERVICE/REPAIR ❑Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 5. Release History: ❑Organic Vapor Analyzer. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑Other,specify. <br /> Documented Groundwater i ontaminati n: <br /> El YES El NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and descriptio of any pre ious investigation or incidence: <br /> UNKNOWN. <br /> 2. Personal Protective Equipment <br /> 6. Potential Health and Safety Level of Protection: ❑A ❑B ❑C ❑D <br /> Physical Concerns:(check 11 that apply&describe) ®Hard Hat. <br /> ❑Hear or Cold Stress: (high ambient temp.) ®Safety Glasses/goggles. <br /> ®Noise Sources: ®Steel toed/shank shoes or boots. <br /> F1 Oxygen Deficiency: <br /> El Flame retardant coveralls. <br /> ®Hearing protection. <br /> ❑Excavation:(falls,trips, lipping,cave-ins): <br /> ❑Tyvek. <br /> ❑Handling and Transfer o a Hazardo is Substance:(fire,explosions, <br /> E3 Respirator: El APR ❑SCBA <br /> etc..): <br /> ❑Confined space entry:(e plosions): A/P cartridge: <br /> ®Heavy equipment(physi al injury trauma resulting from moving ®Safety vest. <br /> equipment): ®Two-way communication. <br /> ❑Other,specify <br /> PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Haz ds: <br /> ❑Snakes ❑Insects Rodents ❑Poisonous PlantsZ 7/o;w <br /> Plan Prepared by: j te: <br /> ®Other/Unknown(speci :UNKNOWN. <br /> Plan Approved by: �/ Date: uf <br /> 8. Narrative(provide all info tion whic could impact Health and Safety, <br /> e.g.,power lines,integrity o dikes,term in,etc.)UNKNOWN. <br /> EH 23081(12/17/2002) <br />