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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SITE HEALTH AND SAFETY PLAN PART I PART II GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS 1. Site Name: Quick Stop Mart 1. Chemicals Hazards Address: 2057 S. EI Dorado St., Stockton ® Carcinogens: waste absorbents Contact Person: Sukhwinder Singh Phone No: 463-6474 ❑ Corrosives: Sweeps Number: _ ❑ Dusts: Proposed Date of investigation/inspection: October 20, 2008 ❑ Explosives: Iters, ® Flammables: waste fuel filters 2. Description and brief narrative of inspection activity: ❑ Inorganic Gases: ❑ New UST installation.. ❑ UAR Investigation. ❑ Metals: ❑ Tank Closure in Place.. ❑ Tank/Pipe Repair. ❑ Oxidizers: ❑ Tank/Pipe Removal. ❑ Re -excavation. ❑ PCB's: ❑ Installation of Borings / Monitoring Wells. ® Hazardous waste inspection ❑ Sampling PART III ❑ Tiered Permitting inspection 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.: Tank Capacity: 1. Monitoring Equipment (note: Monitoring instruments must be used for all operations unless appropriate rationale or restrictions are provided) Tank Content: Tank Age: ❑ Combustible Gas/Oxygen Meter. Other. ❑ Detector Tubes (Specify). ❑ Photo ionization Detector. 4. Type of Operation: Mini Mart ❑ Organic Vapor Analyzer. C3 Other, specify. 5. Release History: Evidence of leaks /soil contamination: ®YES ❑ NO If monitoring instruments are not used, rationale or activity / area restrictions: Documented Groundwater contamination: ® YES ❑ NO Background and description of any previous investigation or incidence: 2. Personal Protective Equipment Level of Protection: ❑ A ❑ B ❑ C ® D ® Hard Hat. 6. Potential Health and Safety ® Safety Glasses/goggles. Physical Concerns: (check all that apply & describe) ® Steel toed/shank shoes or boots. ❑ Heat or Cold Stress: °F (high ambient temp) ❑ Flame retardant coveralls. ❑ Noise Sources: ® Hearing protection. ❑ Oxygen Deficiency: ❑ Tyvek. E]Excavation: (falls, trips, slipping, cave-ins): C] Respirator: APR El SCBA ❑ ® Handling and Transfer of a Hazardous Substance: (fire, explosions, etc..): A/P cartridge: ❑ Confined space entry: (explosions): ® Safety vest. ❑ Heavy equipment (physical injury & trauma resulting from moving ❑ Two-way communication. equipment): ❑ Other, specify PART IV - PLAN APPROVAL 7. Anticipated Biological Hazards: Plan Prepared by: Ray von Flue Date: 10/20/08 ❑ Snakes ❑ Insects ❑ Rodents ❑ Poisonous Plants ❑ Other/Unknown (specify): Plan Approved by: Date: 8. Narrative (provide all information which could impact Health and Safety, e.g., power lines, integrity of dikes, terrain, etc.) EH 23081 (02/19/03)