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SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:HKM Machine and Fabrics ion 1. Chemicals Hazards <br /> Address: 1551 E.8 Mile Rd..Lodi CA 95242 <br /> ®Carcinogens: oil.fuel <br /> Contact Person:Terry Krause No:209 366-1538 <br /> ®Corrosives:battery acid <br /> Sweeps Number: ❑Dusts: <br /> Proposed Date of investigation/inspection:4-11-11 ❑Explosives: <br /> ®Flammables:oil,fuel <br /> 2. Description and brief narrative of inspe,,tion activity: <br /> ❑ Inorganic Gases: <br /> ❑New UST installation. ❑UKR Investigation. ®Metals: <br /> ❑Tank Closure in Place. ❑Ta Pipe Repair. ❑Oxidizers: <br /> ❑Tank/Pipe Removal. ❑R -excavation. ❑PCB's: <br /> ❑Installation of Borings/Monitoring Wells. ❑Other: <br /> ®HW inspection <br /> 3. Specific Site Information: PART III <br /> Tank No.: Ta ik Capacity: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: Ta ik Age: I. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Other: operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation: 4 <br /> [I Detector Tubes(Specify). <br /> 5. Release History: F1 Photo ionization Detector. <br /> Evidence of leaks/soil contamination: ElYES ❑NO El Organic Vapor Analyzer. <br /> ❑Other,specify. <br /> Documented Groundwater contaminate n: ❑YES ❑NO <br /> If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any preN sous investigation or incidence: <br /> 6. Potential Health and Safety 2• Personal Protective Equipment <br /> Physical Concerns:(check all that apply&describe) Level of Protection: ❑A ❑B ❑C OD <br /> ❑Heat or Cold Stress: °F;high ambient temp.) ®Hard Hat. <br /> ®Noise Sources:traffic Z Safety Glasses/goggles. <br /> ❑Oxygen Deficiency: ®Steel toed/shank shoes or boots. <br /> ❑Excavation:(falls,trips,slipping,ca a-ins): F1 Flame retardant coveralls. <br /> ® <br /> ❑Handling and Transfer of a Hazazdo Substance:(fire,explosions, Hearing protection. <br /> etc..): ❑Tyvek. <br /> ❑Confined space entry:(explosions): ❑ Respirator: ❑APR ❑SCBA <br /> ®Heavy equipment(physical injury&trauma resulting from moving A/P cartridge: <br /> equipment):machine sh2p Nuipmen Z Safety vest. <br /> ❑Other,specify ❑Two-way communication. <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes ® Insects ❑Rodents ❑Poisonous Plants <br /> ❑Other/Unknown(specify): Plan Prepared by:Aris Cacapit/ Date:April 13,2011 <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Approved by: v Date: q/1 J <br /> e.g.,power lines,integrity of dikes,term In,etc.) <br /> EH 23081 (12/17/2002) <br />