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'qulN <br /> qo <br /> 2: Z ENVI Old MENTAL HEALTH DhPARTMENT <br /> Pq<<F�R�;Y SAN JOAQUIN COUNTY Program Coordinators <br /> Donna K.Heran,R.E. S. <br /> Director 600 East Main Street, Stockton, California 95202 Kasey L.Foley,R.E.H.S. <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Robert McClellon,R.E.H.S. <br /> ov.or ehd <br /> Jeff Carruesco,R.E.H.S. <br /> Web:www.sjgov.org/ehd Linda Turkatte,R.E.H.S. <br /> SITE HEALTH& SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFO. ATI QQ EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: UC 1. Chemicals Hazards <br /> Address: 7 s ❑Carcinogens: 1�,2 P �� <br /> Contact Person: QM A6214 ❑Corrosives: <br /> Phone#: ❑Dusts: <br /> Proposed Date of investigation/insp tion: ❑Explosives: <br /> ❑Flammables: <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic C,ases� <br /> ❑New UST installation ❑UAR Investigation ❑Metals:[jLll <br /> ❑Tank Closure in Place ❑Tank/Pipe Repair ❑Oxidizers: <br /> ❑Tank/Pipe Removal ❑ e-excavation ❑PCBs: <br /> C3 Sampling ❑ oring/Monitoring Wel]installation C3 Other: <br /> )Z[)H ardous Waste inspection ❑ iered Permitting inspection <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: ank Capacity: 1. Monitoring Equipment(Note:Monitoring instruments must be used for all <br /> Tank Content: ank Age: operations unless appropriate rationale or restrictions are provided): <br /> Other: ❑Combustible Gas/Oxygen Meter <br /> ❑Detector Tubes(specify): <br /> 4. Type of Operation: ❑Photo ionization Detector <br /> ❑Organic Vapor Analyzer <br /> 5. Release History: ❑Other(specify): <br /> Evidence of leaks/soil contaminatio : ❑YES ❑NO ❑None(see below) <br /> Documented Groundwater contamina'on: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any p vious investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health&Safety Physical C ceras:(✓all that apply&describe) Level of Protection: ❑A ❑B ❑C ®D <br /> ❑Heat or Cold Stress: (high ambient temp.) ®Hard Hat <br /> ❑Noise Sources: ®Safety Glasses/Goggles <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots <br /> ❑Excavation(falls,trips,slipping,c;[ve-ins): ❑Flame retardant coveralls <br /> ❑Handling and Transfer of a Hazard us Substance(fire,explosions,etc.): ®Hearing protection <br /> ❑Tyvek <br /> ❑Confined space entry(explosions): ❑Respirator: ❑APR ❑SCBA <br /> ❑Heavy equipment(physical injury trauma resulting from moving A/P Cartridge: <br /> equipment): ®Safety vest <br /> ❑Other(specify): ❑Two-way communication <br /> ❑Other(specify): <br /> 7. Anticipated Biological Hazards: <br /> ❑Snakes ❑Insects ❑Rodeni i ❑Poisonous Plants PART IV <br /> ❑Other/Unknown(specify): PLAN APPROVAL <br /> 8. Narrative(provide all information whi h could impact Health and Safety, Plan Prepared by: Date: LJ I <br /> e.g.,power lines,integrity of dikes,t in,etc.): <br /> Plan Approved by: Date: + <br /> EH 23081 (5/9/2011) <br />