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r <br /> ENVIRONMENTAL HEALTH-DEPARTMENT <br /> Pa� 0 SAN JOAQUIN COUNTY <br /> y Unit Supervisors <br /> Donna K.He R.E.H.S. <br /> a' { Dire cto 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> l Al Olsen,R. .H.S. Stockton California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> Douglas W.Wilson,R.E.H.S. <br /> cq.. �P Program Ma ager Tele hone: 209 468-3420 Margaret La ono R.E.H.S. <br /> 1 r F O R�' Laurie A.og Co ulla,Man RE.H.S. Fax: (2 9) 464-0138 Robert McC ellon,R.E.H.S. <br /> Program Manager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> I. Site Name:Lodi News-Sentinel I. Chemicals Hazards <br /> Address:125 N.Church Street,Lodi,CA 95241 <br /> ®Carcinogens: <br /> Contact Person:Theresa Larson Phone No:(209)369-2761 ❑Corrosives: <br /> Sweeps Number: <br /> ®Dusts: <br /> Proposed Date of investigation/inspection:February 18,2004 ❑Explosives: <br /> ®Flammables: <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. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑ Re-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®Hazardous Waste Inspection ❑Sampling. PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: Tank Age: <br /> operations unless appropriate rationale or restrictions_are provided) <br /> __ _ <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> -- --- ❑Detector Tubes(Specify). <br /> 4 Type of Operation:Newspaper ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: El Other,specify. <br /> Evidence of leaks/soil contamination: <br /> ❑YES ❑NO If monitoring instruments are not used,rationale or activity'area restrictions: <br /> Documented Groundwater contamination: ❑YES ❑NO <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C ®D <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ® <br /> F-1Hearor Cold Stress: °F(high ambient temp.) Steel toed/shank shoes or boots. <br /> ❑F <br /> ®Noise Sources: EQUIPMENT Flame retardant coveralls. <br /> ❑Oxygen Deficiency: ®Hearing protection. <br /> ❑ <br /> ❑Excavation:(falls,trips,slipping,cave-ins): Tyvek. <br /> ❑ <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, Respirator: El APR ❑SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): ®Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ®Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: <br /> Plan Prepared by Datc: <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): / <br /> Plan Approved by: Date: <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 />