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0 0 <br />ENVIRONMENTAL HEALTH DEP <br />ARTMENT <br />Donna K. Heron, R.E.H.S.SAN JOAQUIN COUNTY Program Coordinators <br />Director 1868 E. Hazelton Ave., Stockton, California 95205 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 <br />GENERAL SITE INFORMATION <br />I. Site Name: quality aero <br />Address: 23987 n. hwy 99 <br />Contact Person: <br />Phone N: <br />Proposed Date of investigation/inspection: Jun 27, 2013 <br />2. Description and brief narrative of inspection activity: <br />❑ New UST installation <br />❑ UAR Investigation <br />❑ Tank Closure in Place <br />❑ Tank/Pipe Repair <br />❑ Tank/Pipe Removal <br />❑ Re -excavation <br />❑ Sampling <br />❑ BoringMlonitoring Well installation <br />❑ Hazardous Waste inspection <br />❑ Tiered Permitting inspection <br />® Hazardous Materials Business Plan <br />3. Specific Site Information: <br />Tank No.: <br />Tank Capacity: <br />Tank Content: <br />Tank Age: <br />4. Type of Operation: airplane mechanic <br />S. Release History <br />Evidence of leaks/soil contamination: ❑ YES ❑ NO <br />Documented Groundwater contamination: ❑ YES ❑ NO <br />Background and description of any previous investigation or incidence: <br />6. Potential Health & Safety Physical Concerns. (check all that apply & <br />describe) <br />❑ Heat or Cold Stress: of (high ambient temp.) <br />❑ Noise Sources: <br />❑ Oxygen Deficiency: <br />❑ Excavation (falls, trips, slipping, cave-ins): <br />❑ Handling and Transfer of a Hazardous Substance (fire, explosions, etc.):, <br />❑ Confined space entry (explosions): <br />❑ Heavy equipment (physical injury & trauma resulting from moving <br />equipment): <br />❑ Other (specify): <br />7. Anticipated Biological Hazards: <br />❑ Snakes ❑ Insects ❑ Rodents ❑ Poisonous Plants <br />❑ Other/Unknown (specify): <br />8. Narrative (provide all information which could impact Health and Safety, <br />e.g., power lines, integrity of dikes, terrain, etc.): <br />EH 23081 (8/21/2012) <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />Chemicals Hazards <br />❑ Carcinogens: <br />® Corrosives: <br />❑ Dusts: <br />❑ Explosives: <br />® Flammables: <br />❑ Inorganic Gases: <br />❑ Metals: <br />❑ Oxidizers: <br />❑ PCBs: <br />❑ Other: <br />PART III <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />1. Monitoring Equipment (Note: Monitoring instruments must he used for all <br />operations unless appropriate rationale or restrictions are provided): <br />❑ Combustible Gas/Oxygen Meter <br />❑ Detector Tubes (specify): <br />❑ Photo ionization Detector <br />❑ Organic Vapor Analyzer <br />❑ Other (specify): <br />❑ None (see below) <br />If monitoring instruments are not used, rationale or activity/area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B ❑ C ❑ D <br />❑ Had Hat <br />® Safety Glasses/Goggles <br />R Steel toed/shank shoes or boots <br />❑ Flame retardant coveralls <br />❑ Hearing protection <br />❑ Tyvek <br />❑ Respirator: ❑ APR ❑ SCBA <br />A/P Cartridge: <br />❑ Safety vest <br />❑ Two-way communication <br />❑ <br />Other (specify): <br />PART IV <br />PLAN APPROVAL <br />Plan Prepared by: Jamie DeLaRosa <br />Date: Jun 24, 2013 <br />Plan Approved by:pee Date: <br />