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111 AT INTERSECTION VVITH <br />Kasson Road Overcrossing <br />OR North of <br />STATE OF CALIFORNIA <br />DEPARTMENT OF CALIFORNIA HIGHWAY PATROL <br />INCIDENT ACTION PLAN/SITE SAFETY PLAN <br />CHP 4071 (New 5-15) OPI 062 Refer to HPM 84.2, Chapter 2 <br />INCIDENT DATE (MM/DD/YYYY) <br />05/13/2018 <br />OES CONTROL NUMBER <br />18-3089 <br />INCIDENT TIME (HOURS) <br />0338 <br />AREA DESCRIPTION <br />Rural/Freeway <br />INCIDENT COMMANDER <br /> <br />SITE SAFETY OFFICER <br />Sergant Robert Rickman, ID 14921 <br /> Officer Mike James, ID 18330 <br />INCIDENT ACTION PLAN <br />GENERAL INFORMATION: • PROTECT LIFE, ENVIRONMENT, AND PROPERTY. <br />COMPLY VV1TH SECTION 5192(q), TITLE 8, CALIFORNIA CODE OF REGULATIONS. <br />IDENTIFY THE INCIDENT COMMANDER AND SAFETY OFFICER. <br />PROCEDURES FOR HANDLING EMERGENCY INCIDENTS: <br />gi Identify all hazardous substances or conditions present. <br />Xi Based upon identification, implement appropriate operations, and assure use of proper personal protective equipment. <br />Ensure personnel exposed to inhalation hazard wear a self contained breathing apparatus. <br />Limit the number of personnel on-site, but use the buddy system. <br />Ej Ensure back-ups and standby emergency medical services are available. <br />Designate a safety officer with knowledge of safety operations. <br />ID Implement appropriate decontamination. <br />SITE SAFETY PLAN <br />GENERAL INFORMATION: • PROTECTION OF LIFE IS THE HIGHEST PRIORITY. <br />ENSURE ALL PERSONNEL ARE BRIEFED ON OPERATIONS AND SAFETY BEFORE WORK BEGINS. <br />NO PERSON SHALL EXCEED THEIR LEVEL OF TRAINING, CAPABILITIES, OR RESOURCES. <br />CHEMICAUTRADE NAME <br />Diesal Fuel <br />UN <br />NUMBER <br />1993 <br />DOT HAZARD <br />CLASS <br />3 <br />QUANTITY RELEASED <br />(LBS., GAL., ETC.) <br />20 Gallons <br />EXTENT OF RELEASE <br />Outside vehicle <br />PHYSICAL <br />STATE STORED <br />Liquid <br />PHYSICAL STATE <br />RELEASED <br />Liquid <br />CONTAINER TYPE <br />Vehicular fuel tank <br />CONTAINER CAPACITY (LBS.. GAL., ETC.) <br />100 Gallons <br />CONTAINER MATERIAL <br />Aluminum/Aluminum alloys <br />LEVEL OF CONTAINER <br />Above ground <br />CHEMICAUTRADE NAME UN <br />NUMBER <br />DOT HAZARD <br />CLASS <br />QUANTITY RELEASED <br />(LBS., GAL, ETC.) <br />EXTENT OF RELEASE PHYSICAL <br />STATE STORED <br />PHYSICAL STATE <br />RELEASED <br />CONTAINER TYPE CONTAINER CAPACITY (LBS., GAL., ETC.) CONTAINER MATERIAL LEVEL OF CONTAINER <br />MEDICAL SIGNS OF EXPOSURE: <br />LI Nauseallomiting [11 Coughing <br />111 Dehydration El Tingling/Numbness of extremities <br />Z Trouble breathing 111 Diarrhea <br />1Z Skin irritation LI Unconsciousness <br />Z Dizziness El Anxiety <br />LI Confusion 111 Blurred/Double vision <br />E] Other symptoms: <br />INCIDENT OCCURRED ON <br />Southbound 1-5 <br />An Internationally Accredited Agency Chp4071_0315.pdf Page 1 of 2