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EN IR NMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Donna K.Heran, .E.H.S. Unit Supervisors <br /> Director 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> `J AI Olsen,R.E.4.S. Stockton, California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> • c.. �P • Pro am Man ger Douglas W.Wilson,R.E.H.S. <br /> 40 ii 6'i \ g Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie Cotulla, E.A.S. <br /> Program Mani ger 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 INFORMAI ION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:SB Gas&Marke 1. Chemicals Hazards <br /> Address:515 W.I Ph Street,I rracy,CA <br /> ®Carcinogens: <br /> Contact Person:Tony Garza Phone No:(209)834-8838 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigate /inspectio :May 20,2005 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narratia of inspeci ion activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. ®Metals: <br /> ❑Tank Closure in Place. ❑Ta ipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re xcavation. ❑ PCB's: <br /> ❑installation of Borings/ry lonitoring N iells. <br /> ®Hazardous Waste Inspection ❑Sampling. PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tan c Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content Tan c Age: operations unless appropriate rationale or restrictions are provided) <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> ❑ Detector Tubes(Specify). <br /> 4. Type of Operation:Fuel Statin ❑ Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: Ll Other,specify. <br /> Evidence of leaks/soil conta enation: El YES El NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater co taminatio lus <br /> ❑YES F1 NO <br /> Background and description f any previ investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A [I B ❑C OD <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check all that apply k describe) ®Safety Glasses/goggles. <br /> ® <br /> E]Hear or Cold Stress: °F igh ambient temp.) Steel toed/shank shoes or boots. <br /> ❑Flame retardant coveralls. <br /> ®Noise Sources: E UIPM NT <br /> ®Hearing protection. <br /> ❑Oxygen Deficiency: <br /> ❑Tyvek. <br /> ❑ Excavation:(falls,trips,slipping,cav(-ins): <br /> ❑Respirator: [I APR ❑SCBA <br /> ❑Handling and Transfer of Hazardou Substance:(fire,explosions, <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(exi ilosions): ®Safety vest. <br /> El Heavy equipment(physic I injury& uma resulting from moving ®Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: <br /> Plan Prepared by, ate: <br /> ❑Snakes ❑Insects Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by: Date: <br /> 8. Narrative(provide all information which ould impact Health and Safety, <br /> e.g.,power lines,integrity of(likes,terraii i,etc.):UNKNOWN <br /> EH 23081(12/17/2002) <br />