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aabA�£o ENVIRONMENTAL HEALTH D&ARTMENT SAN JOAQUIN COUNTY program Coordinators Donna K.DirectHeranor R.E.H.S. Kase L.Fol R.E.H.S. Director 600 East Main Street, Stockton,California 95202 Y Foley, Telephone:(209)468-3420 Fax:(209)468-3433 Robert McClellon,R.E.H.S. Jeff Carruesco,R.E.H.S. Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. STTE HEALTH&SAFETY PLAN PART I PART II GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS 1. Site Name 0m 1. `,C,hsemicals Hazards, Address: ryndy/C,aminogens�I .`^S^ Contact Person: MrCormsives: ulYl/- w . &to t� r Phone#: 42017 M— Z(, X ate— C1 Dots Proposed Date of investigation/inspection: [3 Explosives: ISFlemmables: 2. Description and brief narrative of inspection activity: CKIno'game Gases: AVIA tw ❑New UST installation ❑UAR Investigation ]Metals: M0 U ❑Tank Closure in Place ❑Tank/Pipe Repair (rg's2 Oxidizers: ❑Tank/Pipe Removal ❑Re-excavation ❑PCBs: /I ❑Sampling ❑Boring/Monitoring Well installation %Other:ff(-)I`/a Li'rQ1fb�DY""l "�. �� 'Jamkuryl mll to, A. _ _ Hazardous Waste inspection ❑Tiered Permitting inspection 'A'm�11✓LVV1'f l'l h �ceX/�Oj LUl OSP r SDI 19+C� �p.AC PARTIIIa�5lpv�u,��ee0rrr �a.EyykYiv )39 th, Qol�tthcfiha wt4 tO. 3. Specific Site Information: REQUIRED PERSONAL PAO EV&t EQUIPMENT Tank No.: Tank Capacity: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided): Other. ❑Combustible Gas/Oxygen Meter d kAbd rali oma a( ElDetector Tubes(specify): 4. Type of Operation: ri [I Photo ionization Detector ❑Organic Vapor Analyzer 5. Release History: ❑Other(specify): Evidence of Icaks/soil contamination: ❑YES ❑NO 'one(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 So ❑Heat or Cold Stress: °F(high ambient temp.) ®Hard Hat ❑Noise Sources: ®Safety Glasses/Goggles _X_ ,❑DOxygen Deficiency: ®Steel toed/shank shoes or boots y[J Excavation(falls,trips,slipping,cave-ins): C]Flame retardant coveralls /❑_Handling and Transfer of a Hazardous Substance(fire,explosions,etc.); ®Hearing protection ❑Tyvek ❑Confined space entry(explosions): ❑Respirator. ❑APR ❑SCBA [,Heavy equipment(physical injury&trauma resulting from moving A/P Cartridge: equipment): ®Safety vest ❑Other(specify): '`Two-way communication Tt r� - ❑Other(speeify): 7. Anticipated gr�otI ical Hazards: ❑Snakes Ej-Insects Rodents ❑Poisonous Plants PART IV ❑Other/Unknown(specify): PLAN APPROVAL 8. Narrative(provide all infotmation which could impact Health and Safety, Plan Prepared Date: e.g.,Power lines,integrity of dikes,terrain,etc.): Plan Approved by: 1 Date: EH 23081(8/11201.1)