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SAN JOAQ IN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Keystone Automotive Indust res l. Chemicals Hazards <br /> Address:632 S.El Dorado St.,Stockton <br /> ®Carcinogens: <br /> Contact Person:Donald Harrison Phone No:948-1101 ❑Corrosives: <br /> Sweeps Number: ®Dusts: <br /> Proposed Date of investigation/inspect on:July-2006 ❑Explosives: <br /> 31 ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation.. ❑U kR Investigation. ®Metals: <br /> ❑Tank Closure in Place.. ❑Tink/Pipe Repair. <br /> ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑R.--excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. <br /> ®Hazardous waste inspection ❑ Sampling PART III <br /> ❑Tiered Permitting inspection <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: T k Capacity: I. 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:Automotive Industr e ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: [I Other,specify. <br /> Evidence of leaks/soil contamination: F-1 YES NO <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> ❑ <br /> Documented Groundwater contamination: []YES ❑NO <br /> Background and description of any preN sous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C ®D <br /> 6. Potential Health and Safety ®Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. <br /> ❑Heat or Cold Stress: °F(high ambient temp.) ®Steel toed/shank shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: ®Hearing protection. <br /> ElExcavation:(falls,trips,slipping,ca-e-ins): [I Tyvek. <br /> ElHandling and Transfer of a Hazardoi is Substance:(fire,explosions, [I Respirator: ❑APR [I SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): ®Safety vest. <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ❑Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by:Ray von Flue Date:7/26/06 <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by: Date: a . <br /> 8. Narrative(provide all information whict could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terra n,etc.) <br /> EH 23081(02/19/03) <br />