COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

P41!A1!Y, �O�!!y 4 ENVIRONtIENTAL HEALTH DPPARTMENT C`qC%,FpFt�, P SAN JOAQUIN COUNTY Program:Coordinators Donna K.Hewn,R.E. .S. 600 East Main Street, Stockton, California 95202 Kasey L.Foley,R.E.H.S. Director Telephone:(209)468-3420 Fax:(209)468-3433 Robert McClellon,R.E.H.S. Jeff Carruesco,R.E.H.S. Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. SITE HEALTH& SAFETY PLAN PART I PART II GENERAL SITE I FORM 10 EVALUATION OF POTENTIAL HAZARDS 1. Site Name: 1. Chemicals Hazards Address: XCarcinogens: Contact Person: ElCorrosives: Phone#: _. ❑Dusts: Proposed Date of investig tion/inspec ion: D /� ❑ Explosives: Flammables: 2. Description and brief nam Ltive of insp rction activity: ❑ Inorganic Gases: ❑New UST installation ❑ AR Investigation Metals: ❑Tank Closure in Place ❑TankfPipe Repair ❑Oxidizers: ❑Tank/Pipe Removal ❑I e-excavation ❑PCBs: ❑Sampling ❑I bring/Monitoring Well installation [3 Other: �}azardous Waste inspection C]Tiered Permitting inspection // ��'' PART III 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.: ank Capacity: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all Tank Content: _lank Age: operations unless appropriate rationale or restrictions are provided): Other: ❑Combustible Gas/Oxygen Meter ❑Detector Tubes(specify): 4. Type of Operation: ❑Photo ionization Detector ❑Organic Vapor Analyzer 5. Release History: ❑Other(specify): Evidence of leaks/soil co Ff� n ❑YES ❑NO None(see below) Documented Groundwater on: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: Background and descripti vious investigation or incidence: 2. Personal Protective Equipment 6. Potential Health&Safety hysical Co cems:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C OD ❑Heat or Cold Stress: (high ambient temp.) ®Hard Hat Noise Sources: ®Safety Glasses/Goggles El Oxygen Deficiency: ®Steel toed/shank shoes or boots Excavation(falls,trips slipping,c ve-ins): El Flame retardant coveralls Handling and Transfer Df a Hazard us Substance(fire,explosions,etc.): ®Hearing protection ❑Tyvek ❑Confined space entry( xplosions): ❑Respirator: ❑APR ❑SCBA Heavy equipment(physical injury trauma resulting from moving A/P Cartridge: `equipment): ®Safety vest ❑Other(specify): Two-way communication 19rn-e- 0 Other(specify): 7. Anticipated Bi logical H ds: makes nsects �<Rodenls ❑Poisonous Plants PART IV ❑Other/Unknown(speci ): PLAN APPROVAL 8. Narrative(provide all infoi mation whi h could impact Health and Safety, Plan Prepaz Date: e.g.,power lines,integrity of dikes,t in,etc.): ` , ,�` Plan Approved by: v"" Date: EH 23081(9/15/2010)