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ENVIRONMENTAL HEALTH DEPARTMENT <br /> °P SAN JOAQUIN COUNTY <br /> 2: .—c�•--y Unit Supervisors <br /> Q. ? Donna K.Hera R.E.H.S. P <br /> U): ` Directo 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> -" Al Olsen R. P.H.S. Stockton California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> Douglas W.Wilson,R.E.H.S. <br /> Program Mc iager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> F b R Laurie A.Cotull ,R.E.H.S. <br /> Program Mc nager Fax: (209)464-0138 Robert McClellon,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN Mark Barcellos,R.E.H.S. <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:CARNEGIE SVRA I. Chemicals Hazards <br /> Address:18600 CORRAL HOLLOW IROAD.TRACY CA95376 <br /> ❑Carcinogens: <br /> Contact Person:LES BENNETT Phone No:(925)447-0426 ❑Corrosives: <br /> Sweeps Number: <br /> ®Dusts: <br /> Proposed Date of investigation/inspection:June 13,2003 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspe tion activity: <br /> ❑Inorganic Gases: <br /> ❑New UST installation. ❑U R Investigation. ®Metals: <br /> ❑Tank Closure in Place. ❑Ta rik/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑R -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: Tk Age: operations unless appropriate rationale or restrictions are provided) <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:VEHICLE RECRE kTION AREA PARK ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: [I Other,specify. <br /> Evidence of leaks/soil contamination: El YES [I NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contaminatin: ❑YES ❑NO <br /> Background and description of any pre&us investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A [I B ❑C ®D <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> E]Hear or Cold Stress: (high ambient temp.) ®Steel toed/shank shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> El Oxygen Deficiency: ❑ Hearing protection. <br /> ❑Tyvek. <br /> ❑Excavation:(falls,trips,slipping,c ve-ins): <br /> ❑ Respirator: El APR ❑SCBA <br /> ❑Handling and Transfer of a Hazard us Substance:(fire,explosions, <br /> A/P cartridge: <br /> etc..): <br /> ❑Confined space entry:(explosions) ®Safety vest. <br /> ❑Heavy equipment(physical injurytrauma resulting from moving E Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: <br /> Plan Prepared by: P ate: <br /> El Snakes ❑Insects El Roden s ❑Poisonous Plants <br /> ®Other/Unknown(specify): <br /> Plan Approved by: Date:_ <br /> 8. Narrative(provide all information wh ch could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,te rain,etc.):UNKNOWN <br /> EH 23081(12/17/2002) <br />