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SAN JOAUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Sean's Automotive 1. Chemicals Hazards <br /> Address:8423 S El Dorado St.,Frenc Camp <br /> ®Carcinogens:Waste Oil <br /> Contact Person:Sean Rodgers Phone No:234-2507 ❑Corrosives: <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspect on:November 2007 ❑Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrative of insix ction activity: <br /> ❑ Inorganic Gases: <br /> ❑New UST installation.. ❑U kR Investigation. ❑Metals: <br /> ❑Tank Closure in Place.. ❑T ipe Repair. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑R -excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®Hazardous waste inspection ❑ Sampling PART III <br /> ❑Tiered Permitting inspection <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: I. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: Ta k Age: operations unless appropriate rationale or restrictions are provided) <br /> Other. ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Automotive Repair ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: El Other,specify. <br /> Evidence of leaks/soil contamination: <br /> ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contaminate : ❑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 /> F1Heat or Cold Stress: °F high ambient temp.) ®Steel toed/shank shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: ®Hearing protection. <br /> ❑ <br /> F-1 Excavation:(falls,trips,slipping,ca a-ins): Tyvek. <br /> [IHandling and Transfer of a Hazardot s Substance:(fire,explosions, C3 Respirator: ❑APR [:1 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: Plan Prepared by:Ray von Flue Date:11/6/07 <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): 3b <br /> Plan Approved by:� Date:4 <br /> 8. Narrative(provide all information which ould impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terra' ,etc.) <br /> EH 23081(02/19/03) <br />