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C0( Sw{L.E J I <br /> ,Q Y f � Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> G Unit Supervisors <br /> Q' ?� Donna K.Heran,R.E.H.S. 304 East Weber Avenue Third Floor Carl Borgman,R.E.H.S. <br /> Director Mike Huggins,R.E.H.S.,R.D.I. <br /> Al Olsen,R.E.H.S. Stockton, California 95202-2708 Douglas W.Wilson,R.E.H.S. <br /> cq`�FORa�P Program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Laurie A.Cotulla,R.E.H.S. <br /> Program Manager Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:WOOLSEY OIL/VALLEY PACIFIC 1. Chemicals Hazards <br /> Address:23100 S.KASSON ROAD,TRACY,CA 95376 <br /> ®Carcinogens: <br /> Contact Person:HANK MINNEMA Phone No:(209)946-9412 ❑Corrosives: <br /> Sweeps Number: <br /> ®Dusts: <br /> Proposed Date of investigation/inspection:August 21,2003 ❑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. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®Hazardous Waste Inspection ❑Sampling. 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: <br /> operations unless appropriate rationale or restrictions are provided) <br /> _ <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> -- -- ❑Detector Tubes(Specify). <br /> 4. Type of Operation:CARDLOCK ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: El Other,specify. <br /> Evidence of leaks/soil contamination: <br /> ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contamination: ❑YES ❑NO -- <br /> Background and description of any previous investigation or incidence: -- ---- <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C ED <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ElHear or Cold Stress: °F(high ambient temp.) ®Steel toed/shank shoes or boots. <br /> Noise Sources: EQUIPMENT E]Flame retardant coveralls. <br /> ® <br /> ❑Oxygen Deficiency: ®Hearing protection. <br /> E]Excavation:(falls,trips,slipping,cave-ins): El Tyvek. <br /> ❑ ❑ ❑ <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, Respirator: APR SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): ®Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ®Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: 6 <br /> Plan Prepared by: ate: <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): 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.):UNKNOWN <br /> EH 23081 (12/17/2002) <br />