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SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORM TION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:AT&T 1. Chemicals Hazards <br /> Address:124 W.Elm St Lodi CA 952 10 <br /> ®Carcinogens: oil <br /> Contact Person:GM Chin'enti No:925468-8103 <br /> ®Corrosives:lead acid batteries <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investiga'on/inspec on:5-3-11 ❑Explosives: <br /> ®Flammables:oil. <br /> 2. Description and brief narra've of inspot ction activity: <br /> C1 Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. <br /> ®Metals:lead acid batteries <br /> ❑Tank Closure in Place. ❑T k/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑ -excavation. ❑PCB's: <br /> ❑Installation of Borings Monitoring Wells. ❑Other: <br /> ®HW inspection <br /> 3. Specific Site Information: PART III <br /> Tank No.: T ink Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: T urk Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:AT&T emergencvl 2enerator site ❑Detector Tubes(Specify). <br /> 5. Release History: ❑Photo ionization Detector. <br /> Evidence of leaks/soil cot[amination: ElYES [INO El Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> Documented Groundwater ontaminat' n: ❑YES ❑NO <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and descriptioi i of any previous investigation or incidence: <br /> 6. Potential Health and Safety <br /> 2. Personal Protective Equipment <br /> Physical Concerns:(check ill that app &describe) Level of Protection: E]A F)B El C ® D <br /> F1Heat or Cold Stress: (high ambient temp.) ®Hard Hat. <br /> ®Noise Sources:traffic ®Safety Glasses/goggles. <br /> ®Steel toed/shank shoes or boots. <br /> El Oxygen Deficiency: <br /> E]Flame retardant coveralls. <br /> F1Excavation:(falls,trips slipping,cave-ins): <br /> F1Handling and Transfer i of a Hazardous Substance:(fire,explosions, ®Hearing protection. <br /> etc..): ❑Tyvek. <br /> ❑Confined space entry:( xplosions): ❑Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical injury trauma resulting from moving A/P cartridge: <br /> equipment): ®Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological H PART IV-PLAN APPROVAL <br /> ❑Snakes ®Insects ❑Rodent 1 ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Prepared by:Aris Cacapit Date:May 4.2011 11 <br /> 8. Narrative(provide all info�ation which could impact Health and Safety, Plan Approved by: �U Date: I 1 <br /> e.g.,power lines,integrity f dikes,t in,etc.) <br /> EH 23081(12/17/2002) <br />