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ENVI ONMENTAL HEALTH DEPARTMENT <br /> Pa�tN SAN JOAQUIN COUNTY <br /> Q ? Don a K.Her n,R.E.H.S. <br /> Unit Supervisors <br /> < 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> �6, <br /> Direc or Mike Huggins,R.E.H.S.,R.D.I. <br /> Olsen, E.H.s. Stockton, California 95202-2708 Douglas W.Wilson,R.E.H.S. <br /> rogram anager Lauri A.Cotu a,R.E.H.S. <br /> Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Fax: (209) 464-0138 Robert McClellon,R.E.H.S. <br /> rogram nager Mark Barcellos,R.E.H.S. <br /> SITE HEALTH AND SAFETY PLAN <br /> PART PART II <br /> GENERAL SITE INFORMA ION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:Valero 1. Chemicals Hazards <br /> Address: 153 E.11th Street racy,CA <br /> ❑Carcinogens: <br /> Contact Person:Jac ue Hollis Phone No:(209)832-8815 ❑Corrosives: <br /> Sweeps Number: <br /> ®Dusts: <br /> Proposed Date of investigati6n/inspecti n:February 8.2005 ®Explosives: <br /> ®Flammables: <br /> 2. Description and brief narranlonitoring <br /> a of mspe tion activity: <br /> ®Inorganic Gases: <br /> ❑New UST installation. ❑U R Investigation. <br /> El Metals: <br /> F1 Tank Closure in Place. ❑Ta k/Pipe Repair. <br /> ❑Oxidizers: <br /> ElTank/Pipe Removal. ❑Re xcavation. ❑PCB's: <br /> ❑Installation of Borings/ ells. <br /> ®Hazardous Waste Inspect on ❑Sa ling. PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Ta Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: Tan 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 Stati ❑Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: C1 Other,specify. <br /> Evidence of leaks/soil contamination: <br /> ❑YES ®NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contamination ❑YES ®NO <br /> Background and description o any previ us investigation or incidence: <br /> 2. Personal Protective Equipment <br /> Level of Protection: [IA [_1B E3C ®D <br /> 6. Potential Health and Safety <br /> Physical Concerns:(check all hat apply describe) ®Hard Hat. <br /> ® <br /> E]Hear or Cold Stress: °F gh ambient temp.) Safety Glasses/goggles. <br /> ®Noise Sources:Traffic ®Steel toed/shank shoes or boots. <br /> ❑Oxygen Deficiency: ❑Flame retardant coveralls. <br /> ®Hearing protection. <br /> ❑Excavation:(falls,trips,sli ping,cave ins): <br /> ❑Tyvek. <br /> ElHandling and Transfer of a azardous ubstance:(fire,explosions, <br /> [I Respirator: El APR [ISCBA <br /> etc..): <br /> ❑Confined space entry:(expl sions): A/P cartridge: <br /> m <br /> ❑Heavy equipment(physical injury&tr ua resulting from moving ®Safety vest. <br /> equipment): ®Two-way communication. <br /> ❑Other,specify <br /> PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazard <br /> ❑Snakes ❑Insects ❑ Zodents ❑Poisonous Plants Plan Prepared V.Date: <br /> ElOther/Unknown(specify): <br /> Plan Approved by: 29=J Date: <br /> 8. Narrative(provide all infotmat' n which c uld impact Health and Safety, <br /> e.g.,power lines,integrity of di es,terrain, tc.):UNKNOWN <br /> EH 23081 (12/17/2002) <br />