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SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> I. Site Name:DSW AG Inc 1. Chemicals Hazards <br /> Address: 15910 N.Davis Rd.Lodi CA 95242 <br /> ®Carcinogens: oil, diesel,gasoline,propane,antifreeze.solvent. <br /> Contact Person:Charlene Wortley No:209 369-2914 <br /> ®Corrosives:sulfuric acid,bleach <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspect on: ❑Explosives: <br /> ®Flammables:oil,propane,diesel,gasoline,propane,oxygen.sulfur. <br /> 2. Description and brief narrative of ins tion activity: <br /> ❑ Inorganic Gases: <br /> ❑New UST installation. ❑ UAR Investigation. ❑Metals: <br /> ❑Tank Closure in Place. ❑TmkIPipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑ -excavation. ❑PCB's: <br /> ❑ Installation of Borings/Monitoring,Wells. <br /> ®HW inspection ®Other methyl acetylene propadiene—for heating&cutting steel <br /> 3. Specific Site Information: PART III <br /> Tank No.: T ink Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Tank Age: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation:soil conservation aration lantin &cultivating <br /> [I Detector Tubes(Specify). <br /> 5. Release History: F1Photo ionization Detector. <br /> Evidence of leaks/soil contamination: ❑YES F1NO [:1 Organic Vapor Analyzer. <br /> Documented Groundwater contaminate n: <br /> C]YES [I NO [I Other,specify. <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any pre iious investigation or incidence: <br /> 6. Potential Health and Safety 2. Personal Protective Equipment <br /> Physical Concerns:(check all that appl &describe) Level of Protection: ❑A ❑B ❑C OD <br /> ElHeat or Cold Stress: (high ambient temp.) ®Hard Hat. <br /> ®Noise Sources:traffic ®Safety Glasses/goggles. <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots. <br /> ❑Excavation:(falls,trips,slipping,c ve-ins): El Flame retardant coveralls. <br /> ❑Handling and Transfer of a Hazard us Substance:(fire,explosions, ®Hearing protection. <br /> etc..): ❑Tyvek. <br /> ❑Confined space entry:(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ®Heavy equipment(physical injury J,trauma resulting from moving A/P cartridge: <br /> equipment): ®Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes ® Insects ❑Rodents ❑ Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Prepared by:Aris Cacapit Date:January 3.201 1 <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Approved by: V Date: ( <br /> e.g.,power lines,integrity of dikes,ten ain,etc.) <br /> EH 23081 (12/17/2002) <br />