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CONIFIDI TIAL <br /> ENVI ONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Don a K.He n,R.E.H.S. Unit Supervisors <br /> m ti ` Dire for 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> l Olsen E.H.S. Stockton California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> Douglas W.Wilson,R.E.H.S. <br /> rogram anager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> i F o a Lau a A.Co 11a,R.E.H.S. <br /> Fax: (209)464-0138 Robert McClellon,R.E.H.S. <br /> rogram anager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:PRECIOUS AUTO SERV CE CENTER 1. Chemicals Hazards <br /> Address:599 E.11 THTRACY,CA 9 5376 <br /> ❑Carcinogens: <br /> Contact Person:RAY ALIM Phone No:(209)833-6259 ❑Corrosives: <br /> Sweeps Number: <br /> i ®Dusts: <br /> Proposed Date of investigation/inspect on:August 11,2003 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of ins tion activity: <br /> ❑Inorganic Gases: <br /> ❑New UST installation. ❑U R Investigation. ®Metals: <br /> El Tank Closure in Place. ❑T nk/Pipe Repair. El Oxidizers: <br /> ElTank/Pipe Removal. El -excavation. El PCB's: <br /> El Installation of Borings/Monitoring Wells. <br /> ®Hazardous Waste Inspection ❑S ling. PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: T k Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: T k Age: <br /> operations unless appropriate rationale or restrictions are provided) <br /> _ <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:AUTO lIEPAIR ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑Other,specify. <br /> Evidence of leaks/soil con ination: El F-1 NO <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> ur <br /> Documented Groundwater c ntaminatio : ❑YES ❑NO <br /> Background and description f any prev ous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B [I C OD <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check al that apply describe) ®Safety Glasses/goggles. <br /> ®Steel toed/shank shoes or boots. <br /> E]Hear or Cold Stress: °F igh ambient temp.) <br /> ❑ <br /> ®Noise Sources: Flame retardant coveralls. <br /> ®Hearing protection. <br /> ❑Oxygen Deficiency: <br /> ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cav,-ins): <br /> ❑Respirator: F1 APR ❑SCBA <br /> ❑Handling and Transfer of i Hazardous Substance:(fire,explosions, <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(ex losions): ®Safety vest. <br /> ❑Heavy equipment(physiccit <br /> 1 injury& auma resulting from moving ®Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Haz s: Plan Prepared b Date: C�41 <br /> ❑Snakes ❑Insects Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by: Dak <br /> 8. Narrative(provide all informa'on which 4 ould impact Health and Safety, <br /> e.g.,power lines,integrity of ikes,terrai ,etc.):UNKNOWN <br /> EH 23081 (12/17/2002) <br />