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Pqu1N <br /> ENVIR 44ENTAL HEALTH IMPARTMENT <br /> NT <br /> SAN JOAQUIN COUNTY Program Coordinators <br /> ��FOiRa g <br /> Donna K.Heran,R.E. S. <br /> Director 600 East Main Street, Stockton, California 95202 Kasey L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Robert McClellon,R.E.H.S. <br /> Jeff Carruesco,R.E.H.S. <br /> Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATI N EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Walgreens 1. Chemicals Hazards <br /> Address: Carcinogens: <br /> Contact Person: Corrosives: <br /> Phone#: ❑Dusts: <br /> Proposed Date of investigation/inspect on: November 15,2011 ❑Explosives: <br /> Flammables: <br /> 2. Description and brief narrative of insp tion activity: ❑Inorganic Gases: <br /> ❑New UST installation ❑UAR Investigation ❑Metals: <br /> ❑Tank Closure in Place ❑T nk/Pipe Repair ❑Oxidizers: <br /> ❑Tank/Pipe Removal ❑RD-excavation ❑PCBs: <br /> ampling ❑B)ring/Monitoring Well installation ❑Other: <br /> azardous Waste inspection ❑T ered Permitting inspection <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: TAnk Capacity: I. Monitoring Equipment(Note:Monitoring instruments must be used for all <br /> Tank Content: T Age: operations unless appropriate rationale or restrictions are provided): <br /> Other: ❑Combustible Gas/Oxygen Meter <br /> ❑Detector Tubes(specify): <br /> 4. Type of Operation:Retail Pharmacy ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination: ❑YES NO ❑None(see below) <br /> Documented Groundwater contamination: ❑YES NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any preN ious investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health&Safety Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ED <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Hard Hat <br /> ❑Noise Sources: Z Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: Z Steel toed/shank shoes or boots <br /> ❑Excavation(falls,trips,slipping,cav -ins): ❑Flame retardant coveralls <br /> ❑Handling and Transfer of a Hazardot s Substance(fire,explosions,etc.): ®Hearing protection <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ❑HeavY equipment(physical injury'&trauma resulting from moving AIP Cartridge: <br /> equipment): ®Safety vest <br /> ❑Other(specify): ❑Two-way communication <br /> ❑Other(specify): <br /> 7. Anticipated Biological Hazard <br /> El Snakes Insects [Rodents ❑Poisonous Plants PART IV <br /> ❑Other/Unknown(specify): PLAN APPROVAL <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared by: Michelle Michelle H� Date: 11-10-11 <br /> e.g.,power lines,integrity of dikes,terrain,etc.): (� <br /> Plan Approved by:�U Date: <br /> EH 23081(11/10/2011) <br />