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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:James Cotta Vineyards 1. Chemicals Hazards <br /> Address: 10301 W.Peltier Rd.Lodi,CA 95242 ®Carcinogens: oil.fuel <br /> Contact Person:James Cotta No:209 329-0172 ®Corrosives:battery acid <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection:2-23-11 ❑Explosives: <br /> ®Flamm ibles:oil.fuel <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. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. ❑Other <br /> ®HW 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 /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:vinevard ❑Detector Tubes(Specify). <br /> 5. Release History: ❑Photo ionization Detector. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑Organic Vapor Analyzer. <br /> Documented Groundwater contamination: []YES ❑NO ❑Other,specify. <br /> Background and description of any previous investigation or incidence: If monitoring instruments are not used,rationale or activity/area restrictions: <br /> 6. Potential Health and Safety 2. Personal Protective Equipment <br /> Physical Concerns:(check all that apply&describe) Level of Protection: ❑A ❑B ❑C OD <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Hard Hat. <br /> ®Noise Sources:traffic. <br /> ®Safety Glasses/goggles. <br /> ®Steel t retardant ant coveralls. <br /> shoes or boots. <br /> ❑Oxygen Deficiency: <br /> Excavation: falls,tris slipping,cave-ins ❑Flame r <br /> ®Hearing protection. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> etc..): ❑Tyvek. <br /> ❑Confined space entry:(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ®Heavy equipment(physical injury&mum resulting from moving A/P cartridge: <br /> equipment):tmcktors farm vehicles and equipment ®Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes ®Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Prepared by:Aris/CCaacaoit Date:February 23,2011 <br /> \ <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Approved by: 1 U Date: Z Z S II <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(12/17/2002) <br />