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0 0 <br /> SAKI JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Charter Way Chevron 1. Chemicals Hazards <br /> Address:508 W.Charter Way,Stockton <br /> 0 Carcinogens:waste absorbent <br /> Contact Person:Ravinder Singh Phone No:465-3440 ❑Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection:October 22,2008 ❑ Explosives: <br /> ❑Flammables:used fuel filters and hoses <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation- ❑ UAR Investigation. ❑Metals: <br /> ❑Tank Closure in Place.. Q Tank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑ installation of Borings/Monitoring Wells. <br /> ® Hazardous waste inspection ❑ Sampling PART III <br /> Q Tiered Permitting inspection <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: I. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age: <br /> ❑Combustible Gas/Oxygen Meter. <br /> Other: ❑ Detector Tubes(Specify). <br /> 4. Type of Operation:Retail Gasoline Outlet ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑Other,specify. <br /> Evidence of leaks!soil contamination: F]YES F1 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 OD <br /> 6. Potential Health and Safety Z Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ®Steel toed/shank shoes or boots. <br /> Q Heat or Cold.Stress: °F(high ambient temp.) <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ®Hearing protection. <br /> F1 Oxygen Deficiency: <br /> ❑ Excavation:(falls,trips,slipping,cave-ins): El Tyvek. <br /> ❑ Respirator: El APR ❑SCBA <br /> E] Handling and Transfer of a Hazardous Substance:(fire,explosions, <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: Plan Prepared by:Ray von Flue Date: 10/21/08 <br /> ❑Snakes ❑ Insects ❑ Rodents ❑ Poisonous 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.) <br /> EH 23081(02/19/03) <br />