Laserfiche WebLink
O.P�U1N• C <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> Donna K.Heran,R.E.H.S. SAN JOAQUIN COUNTY Program Coordinators <br /> Director 600 East Main Street, Stockton, California 95202 Kasey L. Foley,R.E.H.S. <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Robert McClellon, R.E.H.S. <br /> Web: www.sjgov.org/ehd Jeff Carruesco, R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> PARTI PARTII <br /> GENERAL SITE INFORMA ION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: ✓l CAAIrr 1. Chemicals Hazards <br /> Address: ❑Carcinogens: <br /> Contact Person: Corrosives: T <br /> Phone#: a- ❑Dusts: <br /> Proposed Date of investigation/inspection: -"!?o�J 1 ErExplosives: jj e�P <br /> ❑- mmables:4�� <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 ❑PCBs: <br /> ❑Sampling ❑Boring/Monitoring Well installation Other:J tOX((. Ci� �Y P.Sri0 m rte <br /> 4pazardous Waste inspection E)Tiered Permitting inspection <br /> II 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: operations unless appropriate rationale or restrictions are provided): <br /> Other: ❑Combustible Gas/Oxygen Meter <br /> nn ❑Detector Tubes(specify): <br /> 4. Type of Operation:(tAOAW ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History:a C]Other(specify): <br /> Evidence of leaks/soil c�inattion�:6l YES ❑NO E]None(see below) <br /> Documented Groundwater contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health&SafetJy Physical Concerns:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ®D <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Hard Hat <br /> ❑Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots <br /> ❑Excavation(falls,trips,slipping,cave-ins): ❑Flame retardant coveralls <br /> ❑Handling and Transfer of a Hazardous Substance(fire,explosions,etc.): <br /> ®Hearing protection <br /> ❑Tyvek <br /> El Confined space entry(explosions): EJ Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical injury&trauma resulting from moving <br /> A/P Cartridge: <br /> equipment): ®Safety vest <br /> ❑Other(specify): ❑Two-way communication <br /> ❑Other(specify): <br /> 7. Anticipated Biological Hazards: <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants PART IV <br /> ❑Other/Unknown(specify): PLAN APPROVAL <br /> 1 <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Prepared by: Date:3 y 3 I <br /> e.g.,power lines,integrity of dikes,terrain,etc.): ? <br /> Plan Approved by: J V- Date: J <br /> EH 23081(8/6/2010) <br />