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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Q' Donna IG Heran,RE.H.S. Unit Supervisors <br /> rn: X Director 304 East Weber Avenue, Third Floor Cart Borgman,R.E.H.S. <br /> Al Olsen,RE.H.S. Stockton, California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> Douglas W.Wilson,R.E.H.S. <br /> • c9"Pow— program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie A.Co R.E.H.S.H.S. <br /> Man <br /> Program Manager Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> Mark Barcello�,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN l�O� , <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:COX BROS TIRE SERVICE 1. Chemicals Hazards <br /> Address:507 E.1 In STREET.TRACY.CA 95376 ❑Carcinogens: <br /> Contact Person:EARL BERITSTEIN Phone No:(209)835-0880 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:MAY 23,3003 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. <br /> ❑Metals <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Recxcavation. <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: I. 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:AUTO&TIRE REPAIR ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: [I 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 ZD <br /> 6. Potential Health and Safety N Hard Hat. <br /> Physical Concerns:(check all that apply&describe) N Safety Glasses/goggles. <br /> ❑Hear or Cold Stress: OF(high ambient temp.) ❑Steel toed/shark shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: N Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): ❑Tyvck <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, ❑Respirator: ❑APR ❑SCBA <br /> Mo..): A/P cartridge: <br /> ❑Confined space entry:(explosions): N Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving N Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by: 'UC_ <br /> Date: <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by: D <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 />