COMPLIANCE INFO PRE 2019 - Laserfiche WebLink

Home Browse Search

�obquln ENVIROi ._DENTAL HEALTH D'PPARTMENT Donna K. SAN JOAQUIN COUNTY program Coordinators Director R.E.H.S. 600 East Main Street, Stockton,California 95202 Kasey L.Foley,R.E.H.S. Director Robert McClellon,R.E.H.S. Telephone: (209)468-3420 Fax: (209)468-3433 RJeffCarruesco,R.E.H.S. Web:www.sjgov.org/ehd Linda Turkatte,RE.H.S. SITE HEALTH&SAFETY PLAN PART I PART II GENERAL SITE ORh A N �`/ EVALUATION OF POTENTIAL HAZARDS I. Site Name: �� vrz /) 1. Chemicals Hazards Address: ❑Carcinogens: Contact Person: ❑Corrosives: Phone ❑Dusts: Proposed ateofinvestigation/inspection: IIIS112— ❑Explosives: �, ^ �Flammables: 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 [I Re-excavation ❑PCBs; ❑Sampling E]Boring/Monitoring Well installation ElOther: 14azxrdous Waste inspection ❑Tiered Permitting inspection PART III 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.: Tank Capacity: 1. Monitoring Equipment(Note:Monitoring instruments most be used for all Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided): Other. ❑Combustible Gas/Oxygen Meter ❑Detector Tubes(specify): 4. Type of operation: ❑Photo ionization Detector ❑Organic Vapor Analyzer S. Release History: ❑Other(specify): Evidence of leaks/soil contamination: ❑YES ❑NO None(see below) Documented Groundwater contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: Background and description of any previous investigation or incidence: 2. Personal Protective Equipment 6. Potential Health&Safety Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑ B ❑C OD ❑Heat or Cold Stress: °F(high ambient temp.) N Hard Hat ❑ Noise Sources: ®Safety Glasses/Goggles ❑Oxygen Deficiency: ®Steel toed/sbank shoes or boots �y�W,Excavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls Y�f'Handling and Transfer of a Hazardous Substance(fire,explosions,etc.): ®Hearing protection 7t ❑Tyvek ❑Confined space entry(explosions): ❑Respirator: [I APR ❑SCBA Heavy equipment(Physical injury&nauma resulting from moving A/P Cartridge: uipmnot): N Safety vest � 6'1 n C]Other(specify): Two-way communication P' W r x-rL ❑Other(specify): 7. Anticipated Biological Hazards: ❑Snakes V Insects "14 Rodents ❑Poisonous Plants PART IV ❑Other/Unknown(specify): PLAN APPROVAL 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared by: Date: 1 2- e.g.,power lines,integrity of dikes,terrain,etc.): eU Plan Approved by: Data EH 23081(12/16/2011)