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J JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />SITE HEALTH AND SAFETY PLAN <br />PART <br />GENERAL SITE INFORM <br />1. Site Name: Wilson and C <br />Address: 2617 S. El Dora <br />Contact Person: Bryan Tel <br />Sweeps Number: <br />Proposed Date of investiga <br />2. Description and brief narra <br />❑ New UST installation.. <br />❑ Tank Closure in Place.. <br />❑ Tank/Pipe Removal. <br />❑ Installation of Borings <br />® Hazardous waste inspec <br />❑ Tiered Permitting inspe <br />3. Specific Site Information: <br />Tank No.: <br />Tank Content: <br />Other: <br />TION <br />fey Applia ices <br />i St., Stoct ton <br />;s Phone No: 465-5711 <br />ion/inspec 'on: March 30, 2007 <br />of inspection <br />activity: <br />❑ L <br />AR Investigation. <br />❑ T <br />ink/Pipe Repair. <br />❑ R <br />e -excavation. <br />nitorin <br />Wells. <br />❑ <br />ampling <br />4. Type of Operation: Applianke Rec} <br />5. Release History: <br />Evidence of leaks / soil con minae. <br />Documented Groundwater c ntami <br />Background and description of any <br />6. Potential Health and Safety <br />Physical Concerns: (check a that app" <br />❑ Heat or Cold Stress: °F <br />❑ Noise Sources: <br />❑ Oxygen Deficiency: <br />❑ Excavation: (falls, trips, E lipping, ca <br />❑ Handling and Transfer of a Hazardo <br />etc..): <br />nk Capacity: <br />nk Age: <br />❑ YES ❑ NO <br />n: ❑ YES ❑ NO <br />sous investigation or incidence: <br />& describe) <br />high ambient temp.) <br />e -ins): <br />s Substance: (fire, explosions, <br />❑ Confined space entry: (e losions): <br />❑ Heavy equipment (physic d injury & rauma resulting from moving <br />equipment): <br />❑ Other, specify <br />7. Anticipated Biological Hazar s: <br />❑ Snakes ❑ Insects Rodents ❑ Poisonous Plants <br />❑ Other/Unknown (specify) <br />8. Narrative (provide all inform tion which ould impact Health and Safety, <br />e.g., power lines, integrity of ikes, terrai , etc.) <br />EH 23081 (02/19/03) <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Chemicals Hazards <br />® Carcinogens: Used Oil <br />❑ Corrosives: <br />❑ Dusts: <br />❑ Explosives: <br />❑ Flammables: <br />® Inorganic Gases: Freon <br />❑ Metals: <br />❑ Oxidizers: <br />® PCB's: Capacitors <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 />Plan Prepared by: Ray von Flue Date: 3/29/07 <br />Plan Approved by: Date: <br />