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P4>,tJ1M <br /> ENVI OT ENTAL HEALTH . DEPARTMENT <br /> Donna K.Heran,R.E.H.S. SAN JOAQUIN COUNTY <br /> eq' a`P Director Program Coordinators <br /> 6r i6" 600 E. Main Street Carl Borgman,R.E.H.S. <br /> Laurie A.Cotulla,I LE.H.S. Stockton, California 95202 Mike Huggins,R.E.H.S.,R.D.I. <br /> Assistant Director Kasey L.Foley,R.E.H.S. <br /> Telephone: (209)468-3420 <br /> Margaret Lagorio,R.E.H.S. <br /> Fax: (209).464-0138 Robert McClellon,R.E.H.S. <br /> Web: www.sjgov.org/ehd Jeff Carruesco,R.E.H.S. <br /> SITE HEALTH&SAFETY PLAN <br /> PART I PART H <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:SAM FREITAS TRUCK NG l. Chemicals Hazards <br /> Address:2420 E.EIGHT MILE RD <br /> ❑Carcinogens: <br /> Contact Person:SUSAN SALLEE DOS No209474-0294 ❑Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/insp tion:07/24/07 ❑Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation.. ❑ JAR Investigation. ❑Metals: <br /> ❑Tank Closure in Place.. ❑ ank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑ le-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monito • g Wells. <br /> ®Hazardous waste inspection ❑ Sampling PART IH <br /> ❑Tiered Permitting inspection <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: rank Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content:Tank Age: <br /> operations unless appropriate rationale or restrictions are provided) <br /> Other. ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Truck Maintenance Facility ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑mer'specify. <br /> Evidence of leaks/soil contaminatioi r F1 YES <br /> ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contam tion: ❑YES ❑NO <br /> Background and description of any p vious 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 ap)ly&describe) ®Safety Glasses/goggles. <br /> ❑Heat or Cold Stress: IF(high ambient temp.) ®Steel toed/shank shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: ®Hearing protection. <br /> ®Excavation:(falls,trips,slipping,cave-ins): ❑Tyvek. <br /> ElHandling and Transfer of a Hani Jous Substance:(fire,explosions, ❑Respirator: E]APR E]SCBA <br /> etc..): A/P cartridge: <br /> ❑Confuted space entry:(explosion ): ®Safety vest. <br /> ®Heavy equipment(physical injun &trauma resulting from moving ❑Two-way communication. <br /> equipment): <br /> ❑Other,specify: PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: Plan Prepared by: -- _ Date: <br /> ❑Snakes ❑Insects ❑Rode ats ❑Poisonous Plants <br /> ❑Other/Unknown(specify): <br /> Plan Approved by: N Date: <br /> 8. Narrative(provide all information wliich could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(02/19/03) <br />