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SITE HEALTH AND SAFETY PLAN <br /> PART I PART IIw3 <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Sanborn Chevrolet INC 1. Chemicals Hazards <br /> Address: 1120 S.Cherokee Ln.Lodi A 95240 <br /> ®Carcinogens: oil,coolant <br /> Contact Person:Jerry Curtis No:209 334-5000 <br /> ®Corrosives:car battery acid <br /> Sweeps Number: i Dusts: <br /> Proposed Date of investigation/inspec' n: ❑Explosives: <br /> ®Fmm <br /> laables:oil <br /> 2. Description and brief narrative of ins tion activity: <br /> ❑Inorganic Gases: <br /> F1 New UST installation. ElU Investigation. ❑Metals: <br /> ❑Tank Closure in Place. ❑T k/Pipe Repair. F1Oxidizers: <br /> ElTank/Pipe Removal. ❑R excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. El Other: <br /> ®HW inspection <br /> 3. Specific Site Information: PART III <br /> Tank No.: Ta ftk Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Ta rik Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> operations unless appropriate rationale or restrictions are provided) <br /> Other: <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:auto dealer&service facility ❑Detector Tubes(Specify). <br /> 5. Release History: F-1Photo ionization Detector. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO F1 Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> Documented Groundwater contaminati [3 YES [3 NO <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any p ous investigation or incidence: <br /> 6. Potential Health and Safety 2• Personal Protective Equipment <br /> Physical Concerns:(check all that apply&describe) Level of Protection: ❑A ❑B ❑C ®D <br /> ®Heat or Cold Stress: 95 (high ambient temp.) ®Hard Hat. <br /> ®Safety Glasses/goggles. <br /> ®Noise Sources:traffic <br /> ®Steel toed/shank shoes or boots. <br /> ❑Oxygen Deficiency: <br /> ❑Flame retardant coveralls. <br /> ❑Excavation:(falls,trips,slipping,ca a-ins): <br /> ®Hearing protection. <br /> ❑Handling and Transfer of a Hazardo Substance:(fire,explosions, <br /> etc..): ❑Tyvek. <br /> C3 Confined space entry:(explosions): C3 Respirator: APR ❑SCBA <br /> ❑Heavy equipment(physical injury& rauma resulting from moving A/P cartridge: <br /> equipment): ®Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes ®Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Prepared by:Aris Cacapit Date: + 14,101 <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Approved by: �-/ Date: �� 1 <br /> e.g.,power lines,integrity of dikes,terra' ,etc.) <br /> EH 23081(12/17/2002) <br />