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SAN JOA UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:UP Locomotive Maintenai ice Facility 1. Chemicals Hazards <br /> Address:833 E.Eighth St.,Stockton C.A <br /> ®Carcinogens:used oil <br /> Contact Person:Douglas Honn Phone No:463-0713 ❑Corrosives: <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspec ion:February 2009 ❑Explosives: <br /> ®Flammables:drained used fuel filters <br /> 2. Description and brief narrative of insp xtion activity: <br /> ❑Inorganic Gases: <br /> ❑New UST installation.. ❑I 1AR Investigation. ❑Metals: <br /> ❑Tank Closure in Place.. ❑I ank/Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑Ae-excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitorin Wells. <br /> ®Hazardous waste inspection ❑ Sampling PART III <br /> ❑Tiered Permitting inspection <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: T ank Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: T mk Age: operations unless appropriate rationale or restrictions are provided) <br /> Other. ❑Combustible Gas/Oxygen Meter. <br /> ❑Detector Tubes(Specify). <br /> 4. Type of Operation:Railroad Operatior s and Maintenance Management_ ❑ Photo ionization Detector. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: El 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 contamina n: ®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 app! &describe) ®Safety Glasses/goggles. <br /> ® <br /> ❑Heat or Cold Stress: (high ambient temp.) Steel toed/shank shoes or boots. <br /> ❑Noise Sources: ❑Flame retardant coveralls. <br /> ®Hearing protection. <br /> C3 Oxygen Deficiency: <br /> ❑ <br /> ❑Excavation:(falls,trips,slipping,c ve-ins): Tyvek. <br /> ❑ Handling and Transfer of a Hazardc us Substance:(fire,explosions, ❑Respirator: ❑APR ❑SCBA <br /> etc..): A/P cartridge: <br /> ❑Confined space entry:(explosions): ®Safety vest. <br /> ®Heavy equipment(physical injury 6,trauma resulting from moving ❑Two-way communication. <br /> equipment): <br /> ❑Other,specify PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: <br /> Plan Prepared by:Ray von Flue Date:02/04!09 <br /> ❑Snakes ❑Insects ❑Rodent, ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Approved by: Date: <br /> 8. Narrative(provide all information whic i could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terr iin,etc.) <br /> EH 23081(02/19/03) <br />