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SAN 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:Maxim Crane 1. Chemicals Hazards <br /> Address:2373 Mariposa RD Stockton CA 95205 Carcinogens: -- <br /> Contact Person:Glenn Laviolette Phone No:209.649.6584 ®Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection August 23, 2004 M Explosives: <br /> M 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/Pipc Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑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 /> operations unless appropriate rationale or restrictions are provided) <br /> Tank Content: Tank Age: <br /> ❑Combustible Gas/Oxygen Meter. <br /> Other: <br /> ❑ Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 4. Type of Operation:Rack Manufacture <br /> ❑Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> 5. Release History: <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Evidence of leaks/soil contamination: ❑YES ❑NO <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 ❑ D <br /> Hard Hat. <br /> 6. Potential Health and Safety <br /> M <br /> Physical Concerns:(check all that apply&describe) ®Safety toeGlad/shank <br /> nk shoes. <br /> ❑Heat or Cold Stress: IF(high ambient temp.) <br /> M Steel toedfshank shoes or boots. <br /> ❑Flame retardant coveralls. <br /> ❑Noise Sources: <br /> El Hearing protection. <br /> ❑Oxygen Deficiency: - <br /> ❑Tyvek. <br /> M Excavation:(falls,trips,slipping,cave-ins): <br /> ❑Respirator: ❑APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): El Safety vest. <br /> M Heavy equipment(physical injury&trauma resulting from moving ❑Two-way communication. <br /> m <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: <br /> Plan Prepared by:Dina Abate Date:Augusl,2004 <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 />