Laserfiche WebLink
QpQI?tN, C <br /> y = ENVIRON ENTAL HEALTH DOARTMENT <br /> • Cq iFQ, 'iA.• SAN JOAQUIN COUNTY Program Coordinators <br /> a <br /> Ronna K.Heran,R.E.H.S. <br /> Director 600 East Main Street, Stockton, California 95202 Kersey L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax: (209),468-3433 Robert McClellon,R.E.H.S. <br /> Jeff Camtesco,R.E.H.S. <br /> Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE ORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: Chemicals Hazards <br /> Address: ❑Carcinogens: <br /> Contact Person• ❑Corrosives: <br /> Phone#: ❑Dusts: <br /> Proposed Date of investigation/inspection: ❑Explosives: <br /> ❑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/Pipe Repair ❑Oxidizers: <br /> Tank/Pipe Removal ❑Re-excavation ❑PCBs: <br /> ❑Sampling ❑Boring/Monitoring Well installation ❑Other: <br /> �azardous Waste inspection ❑Tiered Permitting inspection <br /> 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 /> Tank Content Tank Age: operations unless appropriate rationale or restrictions are provided): <br /> Other: ❑Combustible Gas/Oxygen Meter <br /> �} /y�� ��I j� ❑Detector Tubes(specify): <br /> 4. Type of Operation: C,02 �aj IGf�I_I�(1/-L.z ❑Photo ionization Detector <br /> rng �"' <br /> El Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination: ❑YES ❑NO one(see below) <br /> Documented Groundwater contamination: ®YES ❑NO If monitoring instruments arc 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&Safety Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ED <br /> Heat or Cold Stress: °F(high ambient temp.) ®Hard Hat <br /> Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: Steel toed/shank shoes or boots <br /> ❑ <br /> E]Flame retardant coveralls <br /> Excavation(falls,trips,slipping,cave-ins): <br /> Handling and Transfer of a Hazardous Substance(fire,explosions,etc.):, ®Hearing protection <br /> Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR [I SCBA <br /> 3eavy equipment(physical injury&trauma resulting from moving A/P Cartridge. <br /> / equipment): ®Safety vest <br /> ❑Other(specify): )]Two-way communication rT <br /> ❑Other(specify): <br /> 7. Anticipated Biological Hazards: <br /> [:3 � <br /> Snakes 4tcts ❑Rodents ❑Poisonous Plants PART IV <br /> ❑Other/Unknown(specify): PLAN APPROVAL <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared b • Date: leg,f <br /> e.g„power lines,integrity of dikes,terrain,etc.): f <br /> Plan Approved by: ( Date: <br /> EH 23091(3/5/2012) <br />