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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />SITE HEALTH AND SAFETY PLAN <br />PART I <br /> PART II <br />GENERAL SITE INFORMATION <br />EVALUATIO <br />Site Name: ARCO #6020 1. Chemicals <br />Address: 1711 E. Yosemite Ave., Manteca Carcin <br />Contact Person: Bernie Reali Phone No: 823-4715 El Corrosi <br />Sweeps Number: 0 Dusts: <br />Proposed Date of investigation/inspection: October 11, 2004 El Explosi <br />0 F1arnm <br />Description and brief narrative of inspection activity: o Inorgan <br />El New UST installation.. 0 UAR Investigation. 0 Metals: <br />0 Tank Closure in Place.. El Tank/Pipe Repair. o Oxidize <br />0 Tank/Pipe Removal. LI Re-excavation. o PCB's: <br />0 Installation of Borings / Monitoring Wells. <br />El Hazardous waste inspection 0 Sampling PART III Tiered Permitting inspection <br />Specific Site Information: REQUIRED P <br />0 Combu <br />Other: <br />Detector • <br />Photo ionization Detector. <br />4. Type of Operation: Gas Station <br />0 Organic Vapor Analyzer. <br />Other, specify. <br />If monitoring instruments are not used, rationale or activity / area restrictions: <br /> <br /> <br /> <br />Background and description of any previous investigation or incidence: <br />2. Personal Protective Equipment <br />Level of Protection: 0 A <br />El Hard Hat. <br />El Safety Glasses/goggles. <br />Steel toed/shank shoes or boo <br />0 Flame retardant coveralls. <br />Hearing protection. <br />Tyvek. <br />Respirator: 0 APR <br />A/P cartridge: <br />0 B 0 C D <br />. <br />0 SCBA <br />Potential Health and Safety <br />Physical Concerns: (check all that apply & describe) <br />El Heat or Cold Stress: °F (high ambient temp.) <br />0 Noise Sources: <br />C] Oxygen Deficiency: <br />El Excavation: (falls, trips, slipping, cave-ins): <br />El Handling and Transfer of a Hazardous Substance: (fire, explosions, <br />etc..): <br />El Safety vest. <br />0 Two-way communication. <br />PART IV - PLAN APPROVAL <br />Plan Prepared by: Ray von Flue Date: 10/11/04 <br />El Confined space entry: (explosions): <br />0 Heavy equipment (physical injury & trauma resulting from moving <br />equipment): <br />0 Other, specify <br />Anticipated Biological Hazards: <br />Snakes 0 Insects 0 Rodents 0 Poisonous Plants <br />Other/Unknown (specify): Plan Approved by: Date: 10/11/04 <br />Narrative (provide all information which could impact Health and Safety, <br />e.g., power lines, integrity of dikes, terrain, etc.) <br />Tank No.: Tank Capacity: 1. Monitorin <br />o <br />Tank Content: Tank Age: perations <br />q OF POTENTIAL <br />Hazards <br />,gens: <br />HAZARDS <br />yes: <br />yes: <br />ibles: <br />ic Gases: <br />TS: <br />ERSONAL PRI/ <br />Equipment (note <br />unless appropriat <br />;tible Gas/Oxyg <br />TECTIVE EQUIPMENT <br />Monitoring instruments must be used for all <br />rationale or restrictions are provided) <br />Meter. <br />5. Release History: <br />Evidence of leaks / soil contamination: 0 YES 0 NO <br />Documented Groundwater contamination: 0 YES 0 NO <br />EH 23081 (02/19/03)