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ENVIRONMENTAL HEALTH DEPARTMENT <br />QUN SAN JOAQUIN COUNTY <br />P <br />?, Donna K Her tor R E.xs' <br />): Director 304 East Weber Avenue, Third Floor <br />� "' � <br />r. Al Olsen, R.E.H.S. Stockton, California 95202-2708 <br />• c .. <br />Program am Mana er <br />'9��Fo•R�g Telephone: (209) 468-3420 <br />Laurie A. Cotulla, R.E.H.S. <br />Program Manager Fax: (209) 464-0138 <br />SITE HEALTH AND SAFETY PLAN <br />PART <br />GENERAL SITE INFORMATION <br />1. Site Name: TRACY TOYOTA <br />Address: 2895 NGLEE ROAD, TRACY, CA 95304 <br />Contact Person: ED MEYERS Phone No: (209) 481-9320 <br />Sweeps Number: <br />Proposed Date of investigation/inspection: JUNE 03, 2003 <br />2. Description and brief narrative of inspection activity: <br />❑ New UST installation. ❑ UAR Investigation. <br />❑ Tank Closure in Place. ❑ Tank/Pipe Repair. <br />❑ Tank/Pipe Removal. ❑ Re -excavation. <br />❑ Installation of Borings / Monitoring Wells. <br />® Hazardous Waste Inspection ❑ Sampling. <br />is <br />Specific Site Information: <br />Tank No.: Tank Capacity: <br />Tank Content: Tank Age: <br />Other: <br />4. Type of Operation: AUTO REPAIR - DEALERSHIP <br />5. Release History: <br />Evidence of leaks / soil contamination: ❑ YES ❑ NO <br />Documented Groundwater contamination: ❑ YES ❑ NO <br />Background and description of any previous investigation or incidence: <br />6. <br />7 <br />Potential Health and Safety <br />Physical Concerns: (check all that apply & describe) <br />❑ Hear or Cold Stress: °F (high ambient temp.) <br />® Noise Sources: <br />❑ Oxygen Deficiency: <br />❑ Excavation: (falls, trips, slipping, cave-ins): <br />❑ Handling and Transfer of a Hazardous Substance: (fire, explosions, <br />etc..): <br />❑ Confined space entry: (explosions): <br />❑ Heavy equipment (physical injury & trauma resulting from moving <br />equipment): <br />❑ Other, specify <br />Anticipated Biological Hazards: <br />❑ Snakes ❑ Insects ❑ Rodents <br />❑ Other/Unknown (specify): <br />❑ Poisonous Plants <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 />PART II <br />Unit Supervisors <br />Carl Borgman, R.E.H.S. <br />Mike Huggins, R.E.H.S., R.D.I. <br />Douglas W. Wilson, R.E.H.S. <br />Margaret Lagorio, R.E.H.S. <br />Robert McClellon, R.E.H.S. <br />Mark Barcellos, R.E.H.S. <br />COVEN i iAL <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Chemicals Hazards <br />❑ Carcinogens: <br />❑ Corrosives: <br />® Dusts: <br />❑ Explosives: <br />® Flammables: <br />❑ Inorganic Gases: <br />® Metals: <br />❑ Oxidizers: <br />❑ PCB's: <br />PART III <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />1. Monitoring Equipment (note: Monitoring instruments must be used for all <br />operations unless appropriate rationale or restrictions are provided) <br />❑ Combustible Gas/Oxygen Meter. <br />❑ Detector Tubes (Specify). <br />❑ Photo ionization Detector. <br />❑ Organic Vapor Analyzer. <br />❑ Other, specify. <br />If monitoring instruments are not used, rationale or activity / area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B ❑ C ® D <br />® Hard Hat. <br />® Safety Glasses/goggles <br />® Steel toed/shank shoes or boots. <br />❑ Flame retardant coveralls. <br />® Hearing protection. <br />❑ Tyvek. <br />❑ Respirator: ❑ APR ❑ SCBA <br />A/P cartridge: <br />® Safety vest. <br />® Two-way communication <br />PART IV - PLAN APPROVAL <br />Plan Prepared by:, c,�/,Date: t% <br />Plan Approved by: <br />Date: <br />