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ENVIRO�VIENTAL H EALTAEPARTMENT <br /> � z <br /> IC :< <br /> • SAN JOAQUIN COUNTY Donna K.Heron,R.E.H.S. <br /> c. ..P Program Coordinators <br /> Director 600 E. Main Street Carl Borgman,R.E.H.S. <br /> Laurie A.Cotulla,R.E.H.S. Stockton, California 95202 Mike Huggins,R.E.H.S.,R.D.I. <br /> Assistant Director Kasey L.Foley,RE.H.S. <br /> Telephone: (209)468-3420 Margaret Lagorio,R.E.H.S. <br /> Fax: (209).464-0138 Robert McClellon,R.E.H.S. <br /> Web: www.sjgov.org/ehd Jeff Carruesco,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:SUMIDEN WIRE 1. Chemicals Hazards <br /> Address: 1412 EL PINAL DR ®Carcinogens: <br /> Contact Person:WAYNE MANNOR Phone No:466-8924 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspection:6/11/07 ❑Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrative of inspection activity: <br /> ❑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 /> Tiered Permitting inspection <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: operations unless appropriate rationale or restrictions are provided) <br /> Other. ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:WIRE MANUFACTURER ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑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 OD <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ® <br /> ❑Heat or Cold Stress: °F(high ambient temp.) Steel toed/shank shoes or boots. <br /> ®Noise Sources: ❑Flame retardant coveralls. <br /> ®Hearing protection. <br /> ❑Oxygen Deficiency: <br /> ®Excavation:(falls,trips,slipping,cave-ins): ❑Tyvek. <br /> C1 Respirator: E]APR C]SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, <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: Plan Prepared by: ate: 0 <br /> # — <br /> ❑Snakes El Insects El Rodents ❑Poisonous Plants <br /> [IOther/Unknown(specify): Plan Approved by. ate: 1 <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 />