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• <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Donna K.Henan,RE.H.S. 304 East WebAvenue, Third Floor <br /> Director ervenu <br /> Carl 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 /> • c .. P • <br /> Program Manager Douglas W.Wilson,R.E.H.S. <br /> gr e <br /> g Telephone: (209)468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie A.Cotulla,R.E.H.S. <br /> Program Manager Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN Mark Barcellos,R.E.H.S. <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Shell Pipeline Company LP 1. Chemicals Hazards <br /> Address:25705 Patterson Pass Road,Tracy,CA 95376 <br /> ®Carcinogens: <br /> Contact Person:Bob Nissen Phone No:(209)835-3723 ❑Corrosives: <br /> Sweeps Number: <br /> ®Dusts: _ <br /> Proposed Date of investigation/inspection:October 21,2003 ❑Explosives: <br /> N Flammables: <br /> 2. Description and brief narrative of inspection activity: <br /> ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. ®Metals: <br /> ❑Tank Closure in Place. ❑Tank/Pipe 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: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: _Tank Age' <br /> operations unless appropriate rationale or restrictions are provided) <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Pipeline ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: El Other,specify. <br /> Evidence of leaks/soil contamination: YES F-1 NO <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> ❑ <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: [:1 A ❑B ❑C ®D <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ® <br /> C]Hear or Cold Stress: OF(high ambient temp.) Steel toed/shank shoes or boots. <br /> Noise Sources: �UII'MENT <br /> El retardant coveralls. <br /> ® <br /> Oxygen Deficiency: ®Hearing protection. <br /> ❑ <br /> ❑Excavation:(falls,trips,slipping,cave-ins): El Tyvek. <br /> E]Handling and Transfer of a Hazardous Substance:(fire,explosions, El Respirator: El APR El SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): ®Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ®Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by 0 Dater t/J� <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.):UNKNOWN <br /> EH 23081(12/17/2002) <br />