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ENVI ONMENTAL HEALTH .DEPARTMENT <br /> oPc <br /> -.� SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Q. ?� Donn K.Herat,RE.H.S. P <br /> m Directo 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> 1 l <br /> Al Olsen,R. .Hs. Stockton, California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> 7 Douglas W.Wilson,R.E.H.S. <br /> oq..... ....•�v P gram M ager <br /> Laurie A.Cotull ,R.E.H.S. Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> P gram M ager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORM TION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:WILSON WAY TIRE 1. Chemicals Hazards <br /> Address:1133 W.1 IT"STREET, Y CA <br /> ®Carcinogens: <br /> Contact Person:NICK BISI IIKIS Phone No:(209)83511087 ❑Corrosives: <br /> Sweeps Number: <br /> ®Dusts: <br /> Proposed Date of investiga on/inspecti n:MAY 27,2003 ❑Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrat ve of inspe tion activity: <br /> ❑Inorganic Gases: <br /> ❑New UST installation. ❑U R Investigation. ®Metals: <br /> ❑Tank Closure in Place. ❑Ta nk/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑R -excavation. ❑PCB's: <br /> ❑Installation of Borings/ donitoring Wells. <br /> E Hazardous Waste Inspec ion ❑Sa rnpling. PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Ta ik Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: Ta k Age: <br /> 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 OP F-1 Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: El Other,specify. <br /> Evidence of leaks/soil con urination: YES F-1 NO <br /> If monitoring instruments are not used,rationale or activity i area restrictions: <br /> ❑ <br /> Documented Groundwater c ntaminatio : ❑YES ❑NO <br /> Background and description Df any prev ous 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 al that apply&describe) ®Safety Glasses/goggles. <br /> ® <br /> El Hear or Cold Stress: °F high ambient temp.) Steel toed/shank shoes or boots. <br /> ElFlame retardant coveralls. <br /> El Noise Sources: <br /> ❑Oxygen Deficiency: ®Hearing protection. <br /> E]Excavation:(falls,trips,s lipping,ca -ins): El Tyvek. <br /> ❑ <br /> ❑Handling and Transfer of Hazardou Substance:(fire,explosions, El Respirator: E]APR SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(ex)losions): ®Safety vest. <br /> ❑Heavy equipment(physic 1 injury& uma resulting from moving ®Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazar s: V <br /> Plan Prepared b <br /> ❑Snakes ❑Insects Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify) Plan Approved by: D e: <br /> 8. Narrative(provide all info tion which ould impact Health and Safety, <br /> e.g.,power lines,integrity of likes,terrai i,etc.):UNKNOWN <br /> EH 23081 (12/17/2002) <br />