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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />SITE HEALTH AND SAFETY PLAN <br />PART <br />GENERAL SITE INFORMATION <br />1. Site Name: Delta Auto Wreckers <br />Address: 3151 S HWY Stockton CA 95215 <br />Contact Person: Steve Schmidke Phone No: 209.948.6879 <br />Sweeps Number: <br />Proposed Date of investigation/inspection: 12/4/03 <br />2. Description and brief narrative of inspection activity: <br />❑ New UST installation.. <br />❑ UAR Investigation. <br />❑ Tank Closure in Place.. <br />❑ Tank/Pipe Repair. <br />❑ Tank/Pipe Removal. <br />❑ Re -excavation. <br />❑ Installation of Borings / Monitoring <br />Wells. <br />® Hazardous waste inspection <br />❑ Sampling <br />3. <br />Specific Site Information: <br />Tank No.: Tank Capacity: <br />Tank Content: Tank Age: _ <br />Other: <br />4. Type of Operation: Rack Manufacture <br />5. Release History: <br />Evidence of leaks / soil contamination: ❑ YES ❑ NO <br />Documented Groundwater contamination: ❑ YES ❑ NO <br />Background and description of any previous investigation or incidence: <br />6. <br />Potential Health and Safety <br />Physical Concerns: (check all that apply & describe) <br />❑ Heat or Cold Stress: °F (high ambient temp.) <br />® Noise Sources: <br />❑ Oxygen Deficiency: <br />® Excavation: (falls, trips, slipping, cave-ins): <br />❑ Handling and Transfer of a Hazardous Substance: (fire, explosions, <br />etc..): <br />❑ Confined space entry: (explosions): <br />® Heavy equipment (physical injury & trauma resulting from moving <br />eauinment): <br />❑ Other, specify <br />7. Anticipated Biological Hazards: <br />❑ Snakes ❑ Insects ❑ Rodents ❑ Poisonous Plants <br />❑ Other/Unknown (specify): <br />8. Narrative (provide all information which could impact Health and Safety, <br />e.g., power lines, integrity of dikes, terrain, etc.) <br />EH 23081 (02/19/03) <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Chemicals Hazards <br />® Carcinogens: <br />® Corrosives: <br />❑ Dusts: <br />® Explosives: <br />❑ Flammables: <br />❑ Inorganic Gases: <br />® Metals: <br />❑ Oxidizers: <br />❑ PCB's: <br />PART III <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />1. Monitoring Equipment (note: Monitoring instruments must be used for all <br />operations unless appropriate rationale or restrictions are provided) <br />❑ Combustible Gas/Oxygen Meter. <br />❑ Detector Tubes (Specify). <br />❑ Photo ionization Detector. <br />❑ Organic Vapor Analyzer. <br />❑ Other, specify. <br />If monitoring instruments are not used, rationale or activity / area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B ❑ C ❑ D <br />® Hard Hat. <br />® Safety Glasses/goggles. <br />® Steel toed/shank shoes or boots. <br />❑ Flame retardant coveralls. <br />❑ Hearing protection. <br />❑ Tyvek. <br />❑ Respirator: ❑ APR ❑ SCBA <br />A/P cartridge: <br />❑ Safety vest. <br />❑ Two-way communication. <br />PART IV - PLAN APPROVAL <br />1 <br />Plan Prepared by: ' f � V� Date: December 2, 2003 <br />4 Plan Approved by: Date: <br />