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0 0 <br /> 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:KHMCA(Kyoho Manufactuering CA} 1. Chemicals Hazards <br /> Address:2222 S Sinclair Ave.,Stockton <br /> ❑Carcinogens:. <br /> Contact Person:Bill Borton Phone No:941-6200 <br /> ®Corrosives:waste nitric acid <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspection:March 18,2009 ❑Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation.. ❑UAR Investigation. <br /> ❑Metals: <br /> ❑Tank Closure in Place.. ❑Tank/Pipe Repair. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®Hazardous waste inspection ❑ Sampling PART III <br /> El Tiered Permitting inspection <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 /> 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:Industrial Maunfactuering ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑Other,specify. <br /> Evidence of leaks/soil contamination: <br /> ❑,YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions; <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 /> b. Potential Health and Safety Hard Hat. <br /> Physical Concerns:(check all that apply&describe) Safety Glasses/goggles. <br /> ❑ Heat or Cold Stress: °F(high ambient temp.) ®Steel toed/shank shoes or boots. <br /> El Noise Sources: E]Flame retardant coveralls. <br /> ®Hearing protection. <br /> El Deficiency: <br /> E]Excavation:(falls,trips,slipping,cave-ins): C3 Tyvek. <br /> C3 Respirator: ❑APR ❑SCBA <br /> E]Handling and Transfer of a Hazardous Substance:(fire,explosions, <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):forklift <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by:Ray von Flue Date:3/18109 <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants �y <br /> ❑OtherlUnknown(specify): . � _ + <br /> Plan Approved by: 1J�`z 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 />