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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:Verizon Business 1. Chemicals Hazards <br /> Address:2500 W Turner Rd Lodi CA 95242 ❑Carcinogens: <br /> Contact Person:Alan Meier No:(972)729-5671 E Corrosives:lead acid batteries <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection:4-10-13 ❑Explosives: <br /> EFlammables:oil <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. E Metals:oil filters <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipc Removal. ❑Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. E Other:contaminated absorbent. <br /> E HW inspection ❑Tiered Permit inspection PART III <br /> 3. Specific Site Information: <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: <br /> Tank Content: Tank Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> operations unless appropriate rationale or restrictions are provided) <br /> Other: <br /> ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:telecom emergency generator site ❑Photo ionization Detector. <br /> 5. Release History: <br /> ❑Organic Vapor Analyzer. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO <br /> ❑Other,specify, <br /> Documented Groundwater contamination: ❑YES ❑NO <br /> 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 and Safety Level of Protection: ❑A ❑B EIC E D <br /> Physical Concerns:(check all that apply&describe) <br /> E Hard Ha[. <br /> E Heat or Cold Stress: 80 of(high ambient temp.) E Safety Glasses/goggles. <br /> E Noise Sources:traffic <br /> E Steel toed/shank shoes or boots. <br /> ❑Oxygen Deficiency: ❑Flame retardant coveralls. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): E Hearing protection. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, ❑Tyvek. <br /> etc..): <br /> ❑Confined space entry:(explosions): [I Respirator: El APR El SCBA <br /> ❑Heavy equipment(physical injury&trauma resulting from moving <br /> A/P cartridge: <br /> equipment): E Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes E Insects ❑Rodents ❑Poisonous Plants 6Ltp _ <br /> ❑Other/Unknown(specify): Plan Prepared by:Aris Cacaoit Date: <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Approved by: Date: I I <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(12/17/2002) <br />