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SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:AT&T 1. Chemicals Hazards <br /> Address:6855 W.8 Mile Rd.Stockton.CA 95219 <br /> ❑Carcinogens: <br /> Contact Person:Jeff Kacirek Phone No:760 602-8676 ®Corrosives:lead acid batteries <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspect on: ❑Explosives: <br /> ®Flammables:diesel <br /> 2. Description and brief narrative of insp ction activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑U kR Investigation. <br /> ❑Metals: <br /> ❑Tank Closure in Place. ❑T nk/Pipe Repair. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑R,--excavation. <br /> ❑PCB's: <br /> ❑Installation of Borings/Monitorin Wells. <br /> ®HW inspection El Other: <br /> 3. Specific Site Information: PART III <br /> Tank No.: T nk Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: T nk 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:cell tower emer en enerator facili ❑Detector Tubes(Specify). <br /> 5. Release History: ❑Photo ionization Detector. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑Organic Vapor Analyzer. <br /> Documented Groundwater contamination: ❑YES ❑NO ❑Other,specify. <br /> Background and description of any preious investigation or incidence: If monitoring instruments are not used,rationale or activity/area restrictions: <br /> 6. Potential Health and Safety <br /> 2. Personal Protective Equipment <br /> Physical Concerns:(check all that apply&describe) <br /> Level of Protection: ❑A ❑B ❑C ND <br /> ❑Heat or Cold Stress: °F;high ambient temp.) ®Hard Hat. <br /> ®Noise Sources:traffic ®Safety Glasses/goggles. <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots. <br /> ❑Excavation:(falls,trips,slipping,ca)a-ins): ❑Flame retardant coveralls. <br /> ElHandling and Transfer of a Hazard0L s Substance:(fire,explosions, ®Hearing protection. <br /> etc..): ❑Tyvek. <br /> ❑Confined space entry:(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ®Heavy equipment(physical injury& uma resulting from moving A/P cartridge: <br /> equipment):emer ncv generator ®Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes ®Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Prepared by:Aris Cacapit Date:Apri129,2010 <br /> 8. Narrative(provide all information which could impact Health and Safety, b 1 A 1 <br /> e.g.,power lines,integrity of dikes,terrain,etc.) plan Approved y: """ Date: 3 <br /> EH 23081 (12/17/2002) <br />