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tf 4PA�cp'o <br /> ENVIROIENTAL HEALTH DEPARTMENT <br /> ��c;Fawa:Y. <br /> Donna K.Heran,R.E.H.S. SAN JOAQUIN COUNTY program Coordinators <br /> Director 600 East Main Street, Stockton,California 95202 Kaley L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Robert McClellon,R.E.H.S. <br /> Jeff Carruesco,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 INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: L Chemicals Hazards <br /> Address: ❑Cattle, as• petu woo <br /> Contact Person: ❑Corrosives:4U,Ium (S117C� <br /> Phone k: ❑Dusts: <br /> PArro•p'•o ed Da of ijnvesti¢DahoNioGs(p(e�c[�ton: n�271.1 ❑Explosives: G. IIIA � <br /> AMC C """`"�`'� r"`�WD <br /> ❑Flammables:�26D I_. �r'd}'� <br /> 2. Description and brief narrative of inspection activity: ❑Inorganig Gases: Pa i �✓L k1� <br /> ❑New UST installation ❑UAR Investigation ❑Metals:N. <br /> ❑Tank Closure in Place ❑Tank/Pipe Repair ❑Oxidizers: <br /> ❑Tank/Pipe Removal ❑Re-excavation ❑PCBs: <br /> ❑Sampling ❑Boring/Monitoring Well installation ❑IOther: r 11 <br /> �azar7_ <br /> dous Waste inspection (] PAR 3 Tiered Permitting inspection V4�0 ' VAf 3 <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: L 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 /> ,,�, p ❑Detector Tubes(specify): <br /> 4. Type of Operation: 0 U,C�t" =RAM ❑Photo is Vapor Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑None(see below) <br /> Documented Groundwater contamination: ❑YES ❑NO 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&Safety Physical Concerns:(✓a0 that apply&describe) Level of Protection: ❑A ❑B ❑C ®D <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 /> ❑Excavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls <br /> ❑Handling and Transfer of a Hazardous Substance(fire,explosions,etc.):, ®Hearing protection <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical injury&tames resulting from moving A/P Cartridge: <br /> equipment): ®Safety vest <br /> ❑Other(specify): ❑Two-way communication <br /> ❑Other(specify): <br /> 7. Anticipated Biological Hazards: <br /> ❑Snakes ❑Insects ❑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 by: 1 �� Date: 4Z7/1 <br /> e.g.,power lines,integrity of dikes,terrain,etc.): <br /> Plan Approved by: RUE DateKJ v d' <br /> EH 23081(5/9/2011) <br />