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P+RutN ENVIRO*ENTAL HEALTHIbEPARTMENT SAN JOAQUIN COUNTY Program Coordinators Donna K.Heran,R.E.H.S. 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. Director Laurie A.Cotulla,R.E.H.S. Stockton, California 95202 Mike Huggins,R.E.H.S.,R.D.I. Kasey L.Foley, Assistant Director Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S.S. Fax: (209)464-0138 Robert McClellon,R.E.H.S. Web: www.sjgov.org/ehd Jeff Carruesco,R.E.H.S. SITE HEALTH&SAFETY PLAN PART I PART II GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS 1. Site Name:Pep Boys 1—Ghe}rrieals IiEaaaFds Address:4987 West Lane Stockton ❑Carcinogens:[Click here and type] Contact Person: Phone No:[Click here and type] ❑Corrosives:[Click here and type] Sweeps Number:[Click here and typal ❑Dusts:[Click here and typel Proposed Date of investigation/inspection:10/3/10 ❑Explosives:[Click here and typel X Flammables:Solvents 2. Description and brief narrative of inspection activity: ❑Inorganic Gases:[Click here and tvoel ❑New UST installation.. ❑UAR Investigation. ❑Metals:[Click here and typal ❑Tank Closure in Place.. ❑Tank/Pipe Repair. ❑oxidizers:[Click here and typal ❑Tank/Pipe Removal. ❑Re-excavation. ❑PCB's:[Click here and type] ❑Installation of Borings/Monitoring Wells. X Hazardous waste inspection ❑ Sampling PART III ❑Tiered Permitting inspection 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT Tank No.:[Click here and type] Tank Capacity:[Click here and typal 1. Monitoring Equipment(note:Monitoring instruments must be used for all Tank Content:[Click here and typal Tank Age:[Click here and type] operations unless appropriate rationale or restrictions are provided) Other:[Click here and typal ❑Combustible Gas/Oxygen Meter. ❑Detector Tubes(Specify). 4. Type of Operation:[Click here and typal ❑Photo ionization Detector. ❑Organic Vapor Analyzer. 5. Release History: [3 Other,specify. Evidence of leaks/soil contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: Documented Groundwater contamination: ❑YES ❑NO Stay away from hazardous waste sources Background and description of any previous investigation or incidence: [Click here and typal 2. Personal Protective Equipment Level of Protection: ❑A ❑B ❑C ®D 6. Potential Health and Safety ®Hard Hat. Physical Concerns:(check all that apply&describe) ®Safety Glasses/goggles. F1Heat or Cold Stress:(Click here and type]°F(high ambient temp.) ®Steel toed/shank shoes or boots. ❑Flame retardant coveralls. X Noise Sources:Compressor ®Hearing protection. ❑Oxygen Deficiency:[Click here and typal ❑Tyvek. ❑Excavation:(falls,trips,slipping,cave-ins):[Click here and typal ❑Respirator: [_1 APR ❑SCBA ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, A/P cartridge:[Click here and typal etc..):[Click here and typal ❑Confined space entry:(explosions):[Click here and typal ®Safety vest. ❑Heavy equipment(physical injury&trauma resulting from moving Two-way communication. equipment):[Click here and tygel ❑Other,specify:[Click here and type] PART IV-PLAN APPROVAL 7. Anticipated Biological Hazards: Plan Prepared by: Garrett Backus Date: 10/3/10 ❑Snakes ❑hisects ❑Rodents ❑Poisonous Plants ❑Other/Unknown(specify):[Click here and typal Plan Approved by: Date: 8. Narrative(provide all information which could impact Health and Safety, e.g.,power lines,integrity of dikes,terrain,etc.)[Click here and typel EH 23081(02/19/03)