Laserfiche WebLink
Rtyulry 0 a <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> •�'rC]'s3tie1��, SAN JOAQUIN COUNTY program Coordinators <br /> Donna K.Heran,R.E.H.S. Kase L.Fol R.E.H.S. <br /> Director 600 East Main Street, Stockton, California 95202 y <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Robert McClellon,R.E.H.S. <br /> Jeff Carruesco,R.E.H.S. <br /> Web:www.sjgov.org/ehd <br /> SITE HEALTH& SAFETY PLAN <br /> PART PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: n I. Chemicals Hazards <br /> Address: 1 ❑Carcinogens: t,} <br /> Contact Person: ❑Corrosives: <br /> Phone#: ❑Dusts' <br /> Proposed Date of investigation/inspection: '7i0 t Cl Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases:n ran W1,k1 <br /> ❑New UST installation ❑UAR Investigation ❑Metals: <br /> ❑Tank Closure in Place ❑Tank/Pipe Repair ❑Oxidizers: <br /> ❑Tank/Pipe Removal ❑Re-excavation ❑PCBs: <br /> ❑Sampling ❑Boring/Monitoring Well installation ❑Other: <br /> 'Hazardous Waste inspection ❑Tiered Permitting inspection <br /> PARTIII <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: 1. 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: P.bP1YV a Q ❑Photo ionization Detector <br /> wv,.+0 glS ❑Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑None(see below) <br /> Documented Groundwater contamination: ❑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&Safer Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ®D <br /> ®Hard Hat <br /> ❑Heat or Cold Stress: OF(high ambient temlloo�.�)� afety Glasses/Goggles <br /> Noise Sources: A Q "`�BYHr (fatm o" P6t u LL�V_C,(hC Steel toed shank shoes or boots <br /> ❑Oxygen Deficiency: ❑Flame retardant coveralls <br /> ❑Excavation(falls,trips,slipping,cavemins): <br /> ®Hearing protection <br /> ❑Handling and Transfer of Hazardous Substance(fue,explosions,etc.): <br /> ❑Tyvek <br /> ❑Respirator: ❑APR ❑SCBA <br /> ❑Confined space entry(explosions): A/P Cartridge: <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ®Safety vest <br /> equipment): <br /> „aOther(specify). 1A.�k JAuL 14( Two-way communication <br /> TT '' I� l❑'Ottherr(ssp_eciify): <br /> 7. Anticipated Biological Hazards: l.4 I (x4r++ y}. vxl&bl 4 Mk—S �'M <br /> ❑Snakes ❑Insects C3Rodents [I Poisonous Plants PART IV _ <br /> E]Other/Unlotown(specify): fXLL 1�IJ PLAN APPROVAL <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared by: Date:010 4`I <br /> e.g.,power lines,integrity of dikes,terrain,etc.): `^J 1�1y <br /> Plan Approved by: Date: <br /> EH 23081(8/6/2010) <br />