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'ONCk P4.,.CO <br />Q • • Z.l j <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />• cq��FORa�e • SAN JOAQUIN COUNTY Program Coordinators <br />K. Heran, R.E.H.S. <br />Director 1868 E. Hazelton Ave., Stockton, California 95205 Kasey L. Foley, R.E.H.S. <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Robert McClellon, R.E.H.S. <br />Jeff Carruesco, R.E.H.S. <br />Web: www.sjgov.org/ehd Linda Turkatte, R.E.H.S. <br />SITE HEALTH & SAFETY PLAN <br />PART I <br />GENERAL SITE INFORMATION <br />1. Site Name: Temporary HHW Collection Facilit <br />Address: 5749 Tacy Blvd, Tracy <br />Contact Person: Kimbra Andrew <br />Phone #: (209) 468 3066 <br />Proposed Date of investigation/inspection: Sep 21, 2012 <br />2. Description and brief narrative of inspection activity: <br />❑ New UST installation ❑ UAR Investigation <br />❑ Tank Closure in Place ❑ Tank/Pipe Repair <br />❑ Tank/Pipe Removal ❑ Re -excavation <br />❑ Sampling ❑ Boring/Monitoring Well installation <br />® Hazardous Waste inspection ® Tiered Permitting inspection <br />❑ Hazardous Materials Business Pian <br />3. Specific Site Information: <br />Tank No.: Tank Capacity: <br />Tank Content: Tank Age: <br />Other: <br />4. Type of0peration: Temporary HHW Collection Facility <br />5. Release History: <br />Evidence of leaks/soil contamination: ❑ YES ❑ NO <br />Documented Groundwater contamination: ❑ YES ❑ NO <br />Background and description of any previous investigation or incidence: <br />6. Potential Health & Safety Physical Concerns: (check all that apply & <br />describe) <br />❑ Heat or Cold Stress: °F (high ambient temp.) <br />® Noise Sources: <br />❑ Oxygen Deficiency: <br />❑ Excavation (falls, trips, slipping, cave-ins): <br />® Handling and Transfer of a Hazardous Substance (fire, explosions, etc.):. <br />8. <br />❑ Confined space entry (explosions): <br />® Heavy equipment (physical injury & trauma resulting from moving <br />equipment): <br />❑ Other (specify): <br />Anticipated Biological Hazards: <br />® Snakes ® Insects ® Rodents . ❑ Poisonous Plants <br />❑ Other/Unknown (specify): <br />Narrative (provide all information which could impact Health and Safety, <br />e.g., power lines, integrity of dikes, terrain, etc.): <br />EH 23081 (8/21/2012) <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />Chemicals Hazards <br />ISI Carcinogens: <br />® Corrosives: <br />® Dusts: <br />® Explosives: <br />® Fiammables: <br />® Inorganic Gases: <br />® Metals: <br />® Oxidizers: <br />® PCBs: <br />® Other: UnKnown <br />PART III <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />I. Monitoring Equipment (Note: Monitoring instruments must be used for all <br />operations unless appropriate rationale or restrictions are provided): <br />❑ Combustible Gas/Oxygen Meter <br />❑ Detector Tubes (specify): <br />❑ Photo ionization Detector <br />❑ Organic Vapor Analyzer <br />❑ Other (specify): <br />❑ None (see below) <br />If monitoring instruments are not used, rationale or activity/area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B ❑ C ❑ D <br />® Hard Hat <br />® Safety Glasses/Goggles <br />® Steel toed/shank shoes or boots <br />❑ Flame retardant coveralls <br />❑ Hearing protection <br />❑ Tyvek <br />❑ Respirator: ❑ APR <br />A/P Cartridge: <br />® Safety vest <br />® Two-way communication <br />❑ Other (specify): <br />PART IV <br />PLAN APPROVAL <br />❑ SCBA <br />Plan Prepared by: Muniappa Naidu Date: Sep 20, 2012 <br />Plan Approved by: �_' VJ Date: %G i 1- <br />