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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:WASTEEOUIP 1. Chemicals Hazards <br /> Address:11900 E Locke Rd.Lockeford.CA 95237 ®Carcinogens: diesel <br /> Contact Person:Ehseo Alatorre No:(209)333-4414 ❑Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection: -1-U ❑Explosives: <br /> ®Flammables:diesel <br /> 2. Description and brief mutative of inspection activity: ❑ Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. ❑Metals: <br /> ❑Tank Closum in Place. ❑Tank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. ®Other:contaminated absorbent. <br /> ®HW inspection ❑Tiered Permit inspection <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 /> operations unless appropriate rationale or restrictions are provided) <br /> Other: <br /> ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:waste equipment manufacturing comnanv <br /> ❑Photo ionization Detector. <br /> 5. Release History: <br /> Evidence of leaks/soil contamination: [I YES ❑NO ❑agenic Vapor Analyzer. <br /> Documented Groundwater contamination: ❑YES ❑NO ❑Other,specify. <br /> 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 Level of Protection: ❑A ❑B ❑C ®D <br /> Physical Conatus:(check all that apply&describe) Hard <br /> ®Heat m Cold Stress: 95 IF(high ambient temp.) ® Hat <br /> ®Safety Glasses/goggles. <br /> ®Noise Sources:traffic ®Steel toed/shank shoes or boots. <br /> ❑Oxygen Deficiency: <br /> ❑Flame retardant coveralls. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): <br /> ®Hearing protection. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, ❑Tyvek. <br /> etc..): <br /> El Confined space entry:(explosions): C]Respirator: E]APR ❑SCBA <br /> ®Heavy equipment(physical injury&trauma resulting from moving AT cartridge: <br /> equipment):manufacturing epuioement ®Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes ®Insects ❑Rodents ❑Poisonous Plants Q <br /> ❑ <br /> Other/Unknown(specify): Plan Prepared by: -A,T Date: <br /> S. Narrative(provide all information which could impact Health and Safety, Plan Approved b Date: <br /> e.g.,power lines,integrity of dikes,terrain,etc.) PP Y — �� <br /> EH 23081(12/17/2002) <br />