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C1 <br /> ENVIROkENTAL HEALTA)EPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Program Coordinators <br /> Donna K.Heran,R.E.H.S. 304 East Weber Avenue,Third Floor Carl Borgman,R.E.H.S. <br /> Director <br /> Laurie A.Cotulla,R.E.H.S. Stockton, California 95202 Mike Huggins,R.E.H.S.,R.D.I. <br /> Assistant Director Telephone: (209) 468-3420 Kasey L.Foley,R.E.H.S. <br /> Margaret Lagorio,R.E.H.S. <br /> Fax: (209).464-0138 Robert McClellon,R.E.H.S. <br /> Web: www.sjgov.org/chd JeffCarruesco,R.E.H.S. <br /> SITE HEALTH&SAFETY PLAN <br /> PART PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: SfklU 1. Chemicals Hazards <br /> Address: ILSU I 0 Carcinogens: <br /> Contact Persow-15QInj Phone NJInj) d-/Q �Corrosives: <br /> Sweeps Number: J (d Dusts: <br /> Proposed Date of investigationlinspection: 1�1-7 JRf Explosives: <br /> Flaurniables: <br /> 2. Description and brief narrative of inspection activity: El Inorganic Gases: <br /> El New UST installation.. El UAR Investigation. El Metals: <br /> E]Tank Closure in,Place., El Tank/Pipe Repair. El Oxidizers: <br /> El Tank/Pipe Removal. El Re-excavation. El PCB's: <br /> El Installation of Borings/Monitoring Wells, <br /> Hazardous waste inspection El Sampling <br /> Tiered Permitting inspection PART III <br /> 10 <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.; Tank Capacity: 1. 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; E]Combustible Gas/Oxygen Meter, <br /> E]Detector Tubes(Specify), <br /> 4. Type of Operation: n Photo ionization Detector, <br /> El Organic Vapor Analyzer, <br /> 5. Release History: E]Other,specify. <br /> Evidence of leaks/soil contamination: YES NO If monitoring instruments are not used,rationale or activity I area restrictions: <br /> Documented Groundwater contamination: [I YES n NO <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: F-1 A El B D C 0D <br /> 0 Hard Hat, <br /> 6. potential Health and Safety 0 Safety Glasses/goggles. <br /> Physical Concerns:(check all that apply&describe) 0 Steel toed/shank shoes or boots. <br /> n Heat or Cold Stress: 'F(high ambient temp.) El Flame retardant coveralls, <br /> El Noise Sources: 0 Hearing protection. <br /> El Oxygen Deficiency: [-I Tyvek. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): El Respirator: EJ APR E]SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <br /> etc..): AJP cartridge: <br /> Confined space entry:(explosions): 0 Safety vest, <br /> El Heavy equipment(physical injury&trauma resulting from moving El Two-way cominunication. <br /> equipment): <br /> El Other,specify: PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: ,Plan Prepared by: M Naidu Date: 124 -7 If <br /> []Snakes El Insects F1 Rodents [-I Poisonous Plants <br /> Qg,othcdunkoown(specify): I'L 't4 <br /> 4n&A I"%) LVA4-t, t­',�Plan Approved by: 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 />