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'0,P` ENVIRO,VIENTAL HEALTAO)EPARTMENT ❑ UAR Investigation. z� ❑ Tank/Pipe Repair. 'R • • SAN JOAQUIN COUNTY ❑ Installation of Borings / Monitoring Wells. cq K. , R.E.H.S. Donna KHeranS Program Coordinators .. :... �P Director 600 E. Main Street Carl Borgman, R.E.H.S. Laurie A. Cotulla, R.E.H.S. Stockton, California 95202 Mike Huggins, R.E.H.S., R.D.I. Assistant Director Telephone: (209) 468-3420 Kasey L. Foley, R.E.H.S. Margaret Lagorio, R.E.H.S. Fax: (209) 464-0138 Robert McClellon, R.E.H.S. Web: www.sjgov.org/ehd Jeff Carruesco, R.E.H.S. SITE HEALTH & SAFETY PLAN PART I GENERAL SITE INFORMATION 1. Site Name:CHEROKEE FREIGHT Address:5463 CHEROKEE RD Contact Person: STEVE GANNON Phone No:931-3570 Sweeps Number: Proposed Date of investigation/inspection:06/13/07 Description and brief narrative of inspection activity: ❑ New UST installation.. ❑ UAR Investigation. ❑ Tank Closure in Place.. ❑ Tank/Pipe Repair. ❑ Tank/Pipe Removal. ❑ Re -excavation. ❑ Installation of Borings / Monitoring Wells. ® Hazardous waste inspection ❑ Sampling ❑ Tiered Permitting inspection 3. Specific Site Information: Tank No.: Tank Capacity: Tank Content _Tank Age: 4. Type of Operation: Truck Maintenance 5. Release History: Evidence of leaks / soil contamination: ❑ YES ❑ NO Documented Groundwater contamination: ❑ YES ❑ NO Background and description of any previous investigation or incidence: 6. Potential Health and Safety Physical Concerns: (check all that apply & describe) ❑ Heat or Cold Stress: °F (high ambient temp.) ❑ Noise Sources: ❑ Oxygen Deficiency: ® Excavation: (falls, trips, slipping, cave-ins): ❑ Handling and Transfer of a Hazardous Substance: (fire, explosions, etc..): ❑ Confined space entry: (explosions): ® Heavy equipment (physical injury & trauma resulting from moving ❑ Other, specify: 7. Anticipated Biological Hazards: ❑ Snakes ❑ Insects ❑ Rodents ❑ Poisonous Plants ❑ Other/Unknown (specify): 8. Narrative (provide all information which could impact Health and Safety, e.g., power lines, integrity of dikes, terrain, etc.) EH 23081 (02/19/03) PART II EVALUATION OF POTENTIAL HAZARDS 1. Chemicals Hazards ❑ Carcinogens: ® Corrosives: ❑ Dusts: ❑ Explosives: ® Flammables: ❑ Inorganic Gases: ❑ Metals: ❑ Oxidizers: ❑ PCB's: PART IH REQUIRED PERSONAL PROTECTIVE EQUIPMENT 1. Monitoring Equipment (note: Monitoring instruments must be used for all operations unless appropriate rationale or restrictions are provided) ❑ Combustible Gas/Oxygen Meter. ❑ Detector Tubes (Specify). ❑ Photo ionization Detector. ❑ Organic Vapor Analyzer. ❑ Other, specify. If monitoring instruments are not used, rationale or activity / area restrictions: 2. Personal Protective Equipment Level of Protection: ❑ A ❑ B ❑ C ® D ® Hard Hat. ® Safety Glasses/goggles. ® Steel toed/shank shoes or boots. ❑ Flame retardant coveralls. ® Hearing protection. ❑ Tyvek. ❑ Respirator: ❑ APR ❑ SCBA A/P cartridge: ® Safety vest. ❑ Two-way communication. PART IV - PLAN APPROVAL Plan Prepared by: Date: Plan Approved by: Date: