Laserfiche WebLink
ENVIR0 MENTAL HEALTI'DEPARTMENT <br /> pppUiN C v SAN JOAQUIN COUNTY Unit Supervisors <br /> Donna K Heran,R.E.H.S. <br /> 304 East Weber Avenue, Third Floor Carl Borgtnan,R.E.H.S. <br /> Director <br /> Mike Huggins,R.E.H.S.,R.D.I. <br /> At Olsen,R.E.H.S. Stockton California 95202-2708 <br /> s. ' Douglas W.Wilson,R.E.H.S. <br /> Program Manager <br /> gt;FORa Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie A.Co R.E.xR.E.H.S.Progog ram Manager Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> anMark 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 /> L Site Name:American Medical Resoonse 1. Chemicals Hazards <br /> Address:247 Charter Way,Stockton R Carcinogens: <br /> Contact Person:Bob Weatherford Phone No:(209)547-9778 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:November 21.2003 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: <br /> Cl Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. <br /> ®Metals: <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. <br /> ❑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 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:Vehicle Maintenance ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑Other,specify. <br /> Evidence of leaks/soil contamination: <br /> ❑YES ❑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 RD <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 Iced/shank shoes or boots. <br /> ®Noise Sources: EOUIPMENT ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: ®Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): [I Tyvek. <br /> ElHandling and Transfer of a Hazardous Substance:(fire,explosions, ❑Respirator: El APR [I SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): R Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving R Two-way communication. <br /> equipment): <br /> ❑other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: !� Q <br /> El Snakes El insects Plan Prepared by te: <br /> ❑Rodents El Plants <br /> ❑Other/Unknown(specify): Plan Approved by: Date: <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 />