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0 <br /> ENVIRONMENTAL HEALTH EPARTMENT <br /> SAN JOAQUIN COUNTY <br /> _ Unit Supervisors <br /> Donna K.Reran,R.E.H.S. <br /> 304 Fast Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> Director Mike Huggins,R.E.H.S.,R.D.I. <br /> Al Olsen,R.E.H.S. Stockton, California 95202-2708 Douglas W.Wilson,R.E.H.S. <br /> cQC r Fq a�APProgram Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie A.Co R.E.H.S. <br /> Man Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> Program Manager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> I. Site Name:Associated Tractor Service,Inc. I. Chemicals Hazards <br /> Address: 1323 W.Charter Way,Stockton <br /> ®Carcinogens: <br /> Contact Person:Kay Pacillas Phone No:(209)466-3003 ❑Corrosives: <br /> Sweeps Number. <br /> ® Dusts: <br /> Proposed Date of investigation/inspection:January 28,2004 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑ Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. ®Metals: <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. <br /> ❑Oxidizers. <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®Hazardous Waste Inspection ❑Sampling. 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 ContentTank Age: operations unless appropriate rationale or restrictions are provided) <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> —_--- ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Tractor Repair _ ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> F-1 Other,specify. <br /> 5. Release History: <br /> Evidence of locks!soil contamination: El YES El NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contamination: ❑YES ❑NO --�- <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C 0 D <br /> 6. Potential Health and Safety ® Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ❑Hear or Cold Stress: °F(high ambient temp.) ®Steel toed/shank shoes or boots. <br /> Noise Sources: EQUIPMENT El Flame retardant coveralls. <br /> � <br /> Oxygen Deficiency: ❑Hearing protection. <br /> EJExcavation:(falls,trips,slipping,cave-ins): El Tyvck. <br /> ❑ ❑ <br /> EJ Handling and Transfer of a Hazardous Substance:(fire,explosions, El Respirator: APR SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): ®Safety vest. <br /> ❑ Heavy equipment(physical injury&trauma resulting from moving ®Two-way communication. <br /> equipment): <br /> Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: 4 <br /> � Date: <br /> ElSnakes ❑Insects ElRodents ElPoisonous Plants Plan Prepared b)�-*X <br /> ❑Other/Unknown(specify): <br /> Plan Approved by: Datc: _ <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.):UNKNOWN <br /> EH 23081 (12/17/2002) <br />