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a0.4S.N � <br />az4� fps <br />b ENVIRONOENTAL HEALTH DEPARTMENT <br />cat/Pana:� SAN JOAQUIN COUNTY Program Coordinators <br />Donna K Heran, R.E.H.S. Kasey L. Foley, R.E.H.S. <br />Director 1868 E. Hazelton Ave., Stockton, California 95205 Robert McClellon, R.E.H.S. <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Jeff Carruesco, R.E.H.S. <br />Web: www.sjgov.org/ehd Linda Turkatte, R.E.H.S. <br />Rodney Estrada, R.E.H.S. <br />SITE HEALTH & SAFETY PLAN Adrienne Ellsaesser, R.E.H.S. <br />PART <br />GENERAL SITE INFORMATION <br />I. Site Name: SJC Permanent Household Haz Waste <br />Address: 7850 S Ra Brid2eford St. Stockton. CA <br />Contact Person: Joanne Smith-Ri <br />Phone #: (209) 468-3066 <br />Proposed Date of investigation/inspection: 6/26/2013 <br />Description and brief narrative of inspection activity: <br />❑ New UST installation ❑ DAR Investigation <br />❑ Tank Closure in Place ❑ Tank/Pipe Repair <br />❑ Tank/Pipe Removal ❑ Re -excavation <br />❑ Sampling ❑ Boring/Monitoring Well installation <br />® Hazardous Waste inspection ® Tiered Permitting inspection <br />❑ Hazardous Materials Business Plan <br />3. Specific Site Information: <br />Tank No.: Tank <br />Tank Content: Tank <br />4. Type of Operation: Household Hazardous Waste Facility <br />S. Release History: <br />Evidence of leaks/soil contamination: ❑ YES ❑ NO <br />Documented Groundwater contamination: ❑ YES ❑ NO <br />Background and description of any previous investigation or incidence: <br />6. Potential Health & Safety Physical Concerns: (check all that apply & <br />describe) <br />❑ Heat or Cold Stress: of (high ambient temp.) <br />❑ Noise Sources: <br />❑ Oxygen Deficiency: <br />❑ Excavation (falls, trips, slipping, cave-ins): <br />® Handling and Transfer of a Hazardous Substance (fire, explosions, etc.):. <br />❑ Confined space entry (explosions): <br />❑ Heavy equipment (physical injury & trauma resulting from moving <br />❑ Other <br />Anticipated Biological Hazards: <br />❑ Snakes ® Insects ® Rodents ❑ Poisonous Plants <br />❑ Other/Unknown (specify): <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />L Chemicals Hazards <br />® Carcinogens: <br />® Corrosives:_ <br />® Dusts: <br />® Explosives:_ <br />® Flammables:. <br />❑ Inorganic Ga <br />❑ Metals:_ <br />❑ Oxidizers:_ <br />❑ PCBs: <br />❑ Other: <br />PART IH <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />I. Monitoring Equipment (Note: Monitoring instruments must be used for all <br />operations unless appropriate rationale or restrictions are provided): <br />❑ Combustible Gas/Oxygen Meter <br />❑ Detector Tubes (specify): <br />❑ Photo ionization Detector <br />❑ Organic Vapor Analyzer <br />❑ Other (specify): <br />® None (see below) <br />If monitoring instruments are not used, rationale or activity/area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B <br />® Hard Hat <br />® Safety Glasses/Goggles <br />® Steel toed/shank shoes or boots <br />❑ Flame retardant coveralls <br />® Hearing protection <br />❑ Tyvek <br />❑ Respirator: ❑ APR <br />A/P Cartridge: <br />® Safety vest <br />® Two-way communication <br />❑ Other (specify): <br />PART IV <br />PLAN APPROVAL <br />❑ SCBA <br />■ P a <br />Plan Prepared by: C r r /UiU K/ Date: 6-26 3 <br />Narrative (provide all information which could impact Health and Safety, t . <br />e.g., power lines, integrity of dikes, terrain, etc.): Plan Approved by: <br />EH 23081 (6/252013) <br />Date: 6.24• t3 <br />