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SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:J R Simplot i. Chemicals Hazards <br /> Address: 16777 Howland Road,Lathrop <br /> ®Carcinogens: <br /> Contact Person:Ryan Mock Phone No:209 649 9344 ®Corrosives: <br /> Sweeps Number: <br /> ®Dusts: <br /> Proposed Date of investigationlinspection:6/22/10 ❑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. ®Hazardous Waste Inspection. ❑PCB's: <br /> ❑ Installation of Borings/Monitoring Wells. <br /> 3. Specific Site Information: PART III <br /> Tank No.: Tank Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Tank Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:Fertilizer Manufactering ❑ Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 5. Release History: ❑Organic Vapor Analyzer. <br /> Evidence of leaks!soil contamination: El YES [INO [:1 Other,specify. <br /> Documented Groundwater contamination; El 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 and Safety of Protection: ❑A ❑B F-1C C]D <br /> Physical Concerns:(check all that apply&describe) ®Hard Hat. <br /> @fH�r Cold Stress: °F(high ambient temp.) ®Safety toeGlad/shank <br /> nk shoes. <br /> Noise Sources:}� � r ®Steel toed shank shoes or boots. <br /> ElFlame retardant coveralls. <br /> L]Oxygen Deficiency: <br /> ElExcavation: falls,tris slipping,cave-ins El Tyvek, protection. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> ❑Respirator: El APR [__1SCBA <br /> etc..): <br /> ❑Confined space entry:(explosions): A/P cartridge: <br /> Weavy equipment(physical injury&trauma resulting from moving El safety vest. <br /> equipment): ®Two-way communication. <br /> ❑Other,specify <br /> PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: <br /> ®Snakes ® Insects ❑Rodents ❑Poisonous Plants �//��,� 6 2.Z t Q <br /> Plan Prepared by: ��'d a/�'' Date: <br /> ❑Other/Unknown{specify): <br /> 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 /> A�* 4/w <br /> EH 23081(12/1712002) ldkoliaff4, A)�, <br />