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h4�u 1 N. <br /> r' ENVIRONMENTAL HEALTH DEPARTMENT <br /> • C,<<F OIR�`P•• SAN JOAQUIN COUNTY Program Coordinators <br /> Donna K.Heran,R.E.H.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 INFORMATIO EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: S S C ��/J) �C,chemicals Hazards _.- <br /> Address: ) LSI Carcinogens: G11[TT p P ZP, <br /> Contact Person a ❑Corrosives: <br /> Phone#: Dusts: <br /> Proposed Date of investigation/inspection: O 1-7 1 — 1 ❑Explosives: <br /> Flammables: <br /> 2. Description and brief narrative of inspection activity: RLInorganic Gases: <br /> El New UST installation ❑UAR Investigation ❑Metals: V <br /> ❑Tank Closure in Place ❑Tank/Pipe RepairOxidizers:0(l,(,GLP4 <br /> ElTank/Pipe Removal ❑Re-excavation El PCBs: <br /> ��CCJJ <br /> ❑Sampling ❑Boring/Monitoring Well installation ❑Other: <br /> �Wazardous Waste inspection ❑Tiered Permitting inspection <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all <br /> Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided): <br /> Other: ❑Combustible Gas/Oxygen Meter <br /> ( ❑Detector Tubes(specify): <br /> 4. Type of Operation: L j1�(�� ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination: [I YES ❑NO 51one(see below) <br /> Documented Groundwater contamination: C]YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any previous 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 ®D <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Hard Hat <br /> ❑Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots <br /> ❑Excavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls <br /> Handling and Transfer of a Hazardous Substance(fire,explosions,etc.): ®Hearing protection <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> TIeavy equipment(physical injury&trauma resulting from moving A/P Cartridge: <br /> equipment): ®Safety vest <br /> ❑Other(specify): VTwo-way communication On CJ he— <br /> ❑Other(specify): <br /> 7. Anticipated Bi logical Hazards: <br /> ❑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: Date: <br /> e.g.,power lines,integrity of dikes,terrain,etc.): <br /> Plan Approved by: U Date: <br /> EH 23081(8/11/2011) <br />