COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOA?UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SITE HEALTH AND SAFETY PLAN PART I PART II GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS 1. Site Name: Miramar Enterprises 1. Chemicals Hazards Address: 1605 S EI Dorado St., Stocl ton ® Carcinogens: waste test fluid, used absorbent Contact Person: Balaji Angle Phone No: (510) 5524822_ ❑ Corrosives: Sweeps Number: ❑ Dusts: Proposed Date of investigation/insp tion: May 4, 2009 ❑ Explosives: ® Flammables: drained used fuel filters 2. Description and brief narrative of in tion activity: ❑ Inorganic Gases: ❑ New UST installation.. ❑ UAR Investigation. ❑ Metals: ❑ Tank Closure in Place.. ❑'rank/Pipe Repair. ❑ Oxidizers: ❑ Tank/Pipe Removal. ❑ I Ze-excavation. ❑ PCB's: ❑ Installation of Borings / Monitorir Monitor'g Wells. ® Hazardous waste inspection ❑ Sampling PART III ❑ Tiered Permitting inspection 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.: ank Capacity: I . Monitoring Equipment (note: Monitoring instruments must be used for all Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided) ❑ Combustible Gas/Oxygen Meter. Other: ❑ Detector Tubes (Specify). ❑ Photo ionization Detector. 4. Type of Operation: Retail Gasoline 01 itlet ❑ Organic Vapor Analyzer. ❑ mer' specify. 5. Release History: Evidence of leaks / soil contaminatio • ❑ YES ❑ NO If monitoring instruments are not used, rationale or activity / area restrictions: Documented Groundwater contamina 'on: ❑ YES ❑ NO Background and description of any privious investigation or incidence: 2. Personal Protective Equipment Level of Protection: ❑ A ❑ B ❑ C ® D ® Hard Hat. 6. Potential Health and Safety ® Safety Glasses/goggles. Physical Concerns: (check all that appy & describe) ® Steel toed/shank shoes or boots. ❑ Heat or Cold Stress: F (high ambient temp.) ❑ Flame retardant coveralls. ❑ Noise Sources: ® Hearing protection. ❑ Oxygen Deficiency: C3 Tyvek. E]Excavation: (falls, trips, slipping,cave-ins): ❑ Respirator: F1 APR SCBA ❑ [3 Handling and Transfer of a Hazard us Substance: (fire, explosions, etc..): A/P cartridge: ❑ Confined space entry: (explosions) ® Safety vest. ❑ Heavy equipment (physical injury, trauma resulting from moving ❑ Two-way communication. equipment): ❑ Other, specify PART IV - PLAN APPROVAL 7. Anticipated Biological Hazards: Plan Prepared by: Ray von Flue Date: 5/4/09 ❑ Snakes ❑ Insects ❑ Rodent ❑ Poisonous Plants ❑ Other/Unknown (specify): Plan Approved by: Date: 8. Narrative (provide all information which could impact Health and Safety, e.g., power lines, integrity of dikes, ter ain, etc.) EH 23081 (02/19/03)