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SAN JOAQ JIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SITE HEALTH AND SAFETY PLAN PART I PART II GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS 1. Site Name:SRH Food and Gas I. Chemicals Hazards Address:749 E.Charter Way,Stockto ®Carcinogens:used absorbent Contact Person:Muhammad Rizwan Phone No:943-2953 ❑Corrosives: Sweeps Number: C1 Dusts: Proposed Date of investigation/inspec ion:May 13,2008 ❑Explosives: ®Flammables:drained used fuel filters 2. Description and brief narrative of ins tion activity: ❑Inorganic Gases: ❑New UST installation.. ❑ I 1AR Investigation. ❑Metals: ❑Tank Closure in Place.. ❑Tank/Pipe Repair. ❑Oxidizers: ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: ❑Installation of Borings/Monitorin Wells. ®Hazardous waste inspection ❑ 3ampling PART III ❑Tiered Permitting inspection 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.: I ank Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided) Other. ❑Combustible Gas/Oxygen Meter. ❑ Detector Tubes(Specify). 4. Type of Operation:Retail Gasoline Q itlet ❑ Photo ionization Detector. ❑Organic Vapor Analyzer. 5. Release History: ❑Other,specify. Evidence of leaks/soil contaminatio : ®YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: Documented Groundwater contamina'on: ®YES ❑NO Background and description of any p ious investigation or incidence: 2. Personal Protective Equipment Level of Protection: ❑A ❑B ❑C ®D 6. Potential Health and Safety ®Hard Hat. Physical Concerns:(check all that apl ly&describe) ®Safety Glasses/goggles. ❑Heat or Cold Stress: F(high ambient temp.) ®Steel toed/shank shoes or boots. ❑Noise Sources: ❑Flame retardant coveralls. ❑Oxygen Deficiency: ®Hearing protection. ❑ C3 Excavation:(falls,trips,slipping, ave-ins): Tyvek. ❑ ❑ ❑ C1 Handling and Transfer of a Hazar ous Substance:(fire,explosions, Respirator: APR SCBA etc..): A/P cartridge: ❑Confined space entry:(explosions: ®Safety vest. ❑Heavy equipment(physical injury&trauma resulting from moving ❑Two-way communication. equipment): ❑Other,specify PART IV-PLAN APPROVAL 7. Anticipated Biological Hazards: Plan Prepared by:Ray von Flue Date:5/12/08 ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants ❑Other/Unknown(specify): Plan Approved by: Date: 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)