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ENVIRONMENTAL HEALTH DEPARTMENT <br /> U N00SAN JOAQUIN COUNTY <br /> Q ?� Donna K Heran,R.E.H.S. Unit Supervisors <br /> `) 'II Director 304 East Weber Avenue, Third Floor Carl Borgtnan,R.E.H.S. <br /> Al Olsen,R.E.H.S. Stockton California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> 1 Douglas W.Wilson,R.E.H.S. <br /> cq.. .��P Program Manager Telephone: 209 468-3420 <br /> F R Laurie A.Cotulla,R.E.H.S. p ( ) Margaret Lagorio,R.E.H.S. <br /> o <br /> Fax: (209)464-0138 Robert McClellon,R.E.H.S. <br /> Program Manager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:SHELL <br /> 1. Chemicals Hazards <br /> Address:3725 N.TRACY BLUD.TRACY,CA 95376 <br /> ❑Carcinogens: <br /> Contact Person: Phone No: ❑Corrosives: <br /> Sweeps Number: <br /> ❑Dusts: <br /> Proposed Date of investigation/inspection:MAY 19,2003 ®Explosives: <br /> ®Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation ❑Metals: <br /> ❑Tank Closure in Place. ❑Tank/Pipe Repair ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑'Re-excavation. ❑PCB's: <br /> ❑ Installation of Borings/Monitoring Wells. <br /> ®Hazardous Waste Inspection ❑Sampling. PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.:4 Tank Capacity:48,000 _ 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided) <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:GAS STATION ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ❑Other,specify. <br /> Evidence of leaks/soil contamination: 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 previous 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 /> ® <br /> [I Hear 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 /> ❑ <br /> ❑Excavation:(falls,trips,slipping,cave-ins): Tyvek. <br /> E]Respirator: [I APR ❑SCBA <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, A/p cartridge: <br /> etc..): <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 b Date: _ <br /> El Snakes ❑Insects ❑Rodents ❑Poisonous Plants <br /> ElOther/Unknown(specify): Plan Approved by: Da <br /> 9 <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.):UNKNOWN <br /> EH 23081 (12/17/2002) <br />