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ENV <br />Donna K. Heran, <br />Director <br />Laurie A. Cotulla, <br />Assistant Dirc <br />PART <br />GENERAL SITE INFORMATION <br />1. Site Name: Miramar Enterprises <br />2. <br />0 <br />Address: 1605 S. EI Dorado St. St <br />Contact Person: Balaii Angle Phone <br />Sweeps Number: <br />Proposed Date of investigation/inspe <br />Description and brief narrative of inspe <br />❑ New UST installation.. <br />❑ U. <br />❑ Tank Closure in Place.. <br />❑ Te <br />❑ Tank/Pipe Removal. <br />❑ R4 <br />❑ Installation of Borings / Monitoring <br />® Hazardous waste inspection <br />❑ S <br />❑ Tiered Permitting inspection <br />Specific Site Information: <br />Tank No.: <br />Ta <br />Tank Content:_ Tank Age: <br />Other: <br />4. Type of Operation: <br />5. Release History: <br />Evidence of leaks / soil contamination: <br />Documented Groundwater contaminati <br />Background and description of any pre <br />OAENTAL HEALTHOEPARTMENT <br />6. Potential Health and Safety <br />Physical Concerns: (check all that apply <br />❑ Heat or Cold Stress:_ °F (high ambiei <br />❑ Noise Sources: <br />❑ Oxygen Deficiency: <br />❑ Excavation: (falls, trips, slipping, ca) <br />❑ Handling and Transfer of a Hazardot <br />etc..): <br />❑ Confined space entry: (explosions): - <br />❑ Heavy equipment (physical injury & <br />equipment): <br />❑ Other, specify: <br />7. Anticipated Biological Hazards: <br />❑ Snakes ❑ Insects ❑ Rodents <br />❑ Other/Unknown (specify): <br />SAN JOAQUIN COUNTY <br />304 East Weber Avenue, Third Floor <br />Stockton, California 95202 <br />Telephone: (209) 468-3420 <br />Fax: (209) 464-0138 <br />Web: www.sjgov.org/ehd <br />SITE HEALTH & SAFETY PLAN <br />(510)552-4822 <br />r August 14. 2006 <br />ion activity: <br />2 Investigation. <br />k/Pipe Repair. <br />:xcavation. <br />/ells. <br />npling <br />c Capacity: <br />® YES ❑ NO <br />® YES ❑ NO <br />investigation or incidence: <br />describe) <br />temp.) <br />Substance: (fire, explosions, <br />resulting from moving <br />❑ Poisonous Plants <br />8. Narrative (provide all information whichould impact Health and Safety, <br />e.g., power lines, integrity of dikes, terrai , etc.) <br />EH 23081 (02/19/03) <br />Program Coordinators <br />Carl Borgman, R.E.H.S. <br />Mike Huggins, R.E.H.S., R.D.I. <br />Kasey L. Foley, R.E.H.S. <br />Margaret Lagorio, R.E.H.S. <br />Robert McClellon, R.E.H.S. <br />Jeff Carruesco, R.E.H.S. <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Chemicals Hazards <br />® Carcinogens: Gasoline <br />❑ Corrosives: <br />❑ Dusts: <br />❑ Explosives: <br />® Flammables: Gasoline <br />❑ Inorganic Gases: <br />❑ Metals: <br />❑ Oxidizers: <br />❑ PCB's: <br />PART III <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />1. 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 />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 ❑ SCBA <br />A/P cartridge: <br />® Safety vest. <br />❑ Two-way communication. <br />PART IV - PLAN APPROVAL <br />Plan Prepared by: Ray von Flue Date: 8/10/06 <br />Plan Approved by: Date: <br />