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EPA Region 5 Records Ctr. 231035 100 CORPORATE NORTH SUITE 101 ROUTE 22 AND LAKESIDE DRIVE BANNOCKBURN. ILLINOIS 60015 (312)295-6020 November 7, 1985 Mr. Jeffrey J. Larson, L.A. Project Manager DLPU HSCS 2200 Churchill Road Springfield, IL 62706 Re: Belvidere Health and Safety Plan Dear Mr. Larson: Enclosed for your review are five copies of the Health and Safety Plan for the Belvidere Municipal Landfill No. 1 site. The plan covers all subject areas covered in the example provided by Mr. Douglas Crandall. At the same time as you are reviewing this draft, our Corporate Health and Safety Officer will be reviewing it also. Mr. Loch, the Safety Officer for Weston's Chicago office, was involved in the preparation of the plan, but was unavailable to sign it. We would appreciate any comments on this material. Very truly yours, ROY F. WESTON, INC. Rj Michael Bort, P.E. NOV05 !3=i

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EPA Region 5 Records Ctr.

231035

100 CORPORATE NORTH SUITE 101ROUTE 22 AND LAKESIDE DRIVEBANNOCKBURN. ILLINOIS 60015(312)295-6020

November 7, 1985

Mr. Jeffrey J. Larson, L.A.Project ManagerDLPU HSCS2200 Churchill RoadSpringfield, IL 62706

Re: Belvidere Health and Safety Plan

Dear Mr. Larson:

Enclosed for your review are five copies of the Health and SafetyPlan for the Belvidere Municipal Landfill No. 1 site. The plancovers all subject areas covered in the example provided by Mr.Douglas Crandall.

At the same time as you are reviewing this draft, our CorporateHealth and Safety Officer will be reviewing it also. Mr. Loch,the Safety Officer for Weston's Chicago office, was involved inthe preparation of the plan, but was unavailable to sign it. Wewould appreciate any comments on this material.

Very truly yours,

ROY F. WESTON, INC.

Rj Michael Bort, P.E.

NOV05 !3=i

HEALTH AND SAFETY PLANREMEDIAL INVESTIGATION/FEASIBILITY STUDY

Belvidere Municipal LandfillBelvidere, Illinois

NOVEMBER 1985

PROJECT MANAGER: R. Michael Bort, P.E.

PREPARED BY:

REVIEWED BY:

Daniel R. Malinovski

C. .

APPROVED BY:

APPROVED BY:

Edward A. Need, P.G.Remedial Investigation Team Leader

Michael L. LochWESTON Regional Safety Officer

George CrawfordWESTON Corporate Safety Officer

TABLE OF CONTENTS

Section Page

1.0 INTRODUCTION 1-1

1.1 Objectives ' l-l1.2 Site Description 1-11.3 Chemical Hazards 1-41.4 Description of Projected Site Activities 1-61.5 Health and Safety Responsibilities 1-6

2.0 FIELD HEALTH AND SAFETY PROCEDURES 2-1

2.12.2

2.3

2.4

2.5

2.6

2.7

General Work RulesHealth, Safety and Medical MonitoringProgramsWork Zone Definition

2.3.1 Exclusion Zone2.3.2 Contaminant Reduction Zone2.3.3 Support Zone

Personnel Protection Procedures

2.4.1 Levels of Protection2.4.2 On-Site Medical Monitoring

Decontamination Procedures

2.5.1 Personnel and Sampling Equipment2.5.2 Vehicles

Air Monitoring Procedures and Response

Contingency Measures

2.7.1 Chemical Exposure2.7.2 Physical Injury2.7.3 Fire/Explosion/Release of

Toxic Gases

DOCUMENTATION

TOXICOLOGICAL PROPERTIES AND HANDLING

2-12-2

2-2

2-32-32-3

2-3

2-32-7

2-10

2-102-12

2-12

2-15

2-152-172-17

3-1

4-1

3.0

4.0PROCEDURES OF KNOWN CONTAMINANTS

APPENDIX A Analysis Results

APPENDIX B Work Location Personnel Protection andSafety Evaluation Form

APPENDIX C Heat Stress and Cold Exposure Monitoring

APPENDIX D Forms for Site Documentation

LIST OF TABLES

Table Page

2-1 Levels of Protection for Various 2-6Field Activities

2-2 Criteria for Selection and Personnel 2-8Protective Equipment for Level D

v

2-3 Criteria for Selection and personnel 2-9Protective Equipment for Level C

2-4 Atmospheric Hazard Guidelines 2-13

2-5 List of First Aid Equipment 2-18

LIST OF FIGURES

Figure Page

1-1 Site Location 1-2

1-2 Site Map 1-3

1-3 Suspected Location of Hazardous 1-5Waste Disposal

2-1 Work Zone Map 2-4

2-2 Personnel Decontamination Line 2-5

2-3 Sampling Equipment Decontamination 2-11Station

2-4 Route to Hospital 2-16

Belvidere Health and Safety PlanNovember 7, 1985Page No: 1-1

1.0 INTRODUCTION

1.1 OBJECTIVES

This Health and Safety Plan (HSP) provides procedures to beemployed during Remedial Investigations at the BelvidereLandfill site in Belvidere, Illinois. This plan includesprotocol required for all work conducted at the site andspecific procedures for individual tasks. The Health andSafety Plan is designed to meet the following objectives:

o Provides a detailed site description includinglocation, history, current status and definitionof hazards.

o Defines personnel responsibilities for Health andSafety, implementation and oversight.

o Provides general work rules pertinent to all sitework.

o Defines work zones and respective safetyprocedures and levels of protection.

o Defines on-site medical monitoring, equipment andpersonnel decontamination procedures.

o Defines air monitoring procedures and use inestablishing levels of protection.

o Defines emergency contingency procedures forphysical injury, chemical exposure, explosion andfire incidents.

o Defines the documentation requirements for Healthand Safety Plan implementation.

o Provides background data and information on thechemical and toxicological properties of knowncontaminants.

1.2 SITE DESCRIPTION

The Belvidere/Municipal No. 1 Landfill is located on thewestern edge of Belvidere, Illinois, near Appleton Road.The site is in the NW 1/4, NE 1/4, SW 1/4 of Section 27,T.44N, R.3E, Boons County, Illinois. The site location andsite map are shown in Figures 1-1 and 1-2, respectively.The site consists of Boone County Conservation Districtproperty (139 acres) , of which 11 acres have been used forlandfilling.

SCALE IN MILES

SOURCE: RandMcNilly

FIGURE 1-1SITE LOCATION

GRAVELPIT

(ABANDONED). d'.C-C '.T ''••' \ (ABANI

SECTION BOUNDARY

GRAVEL PIT BOUNDARY

PROPERTY BOUNDARY

LANDFILL BOUNDARY

WASTE DISPOSAL BOUNDAR

COURCE: IEPA. 1981FIGURE 1-2

SITE MAP^V I

Belvidere Health and Safety PlanNovember 7, 1985Page No: 1-4

The Kishwaukee River bordering the southern and westernportions of the site is the dominant hydrological feature ofthe area. The site consists of former gravel pits of whichone was utilized for disposal of various wastes. Severalponds still exist on the site to the east and north of thewaste disposal area. In general, the landfill extends towithin approximately 700 feet of the Kishwaukee River.There is an operating gravel pit on the north side of theproperty, and portions of the property not affected bylandfilling operations contain park roads and trails open tothe public. The landfill is covered and supports secondaryvegetative growth.

The Belvidere/Municipal #1 Landfill was operated by the Cityof Belyidere from 1939 to 1965. It is believed that onlymunicipal wastes were deposited during this time. Thisoperation included open burning from November 4, 1965 toJanuary, 1971, the City contracted Rockford DisposalService, Inc. to operate the landfill. The landfill wasoperated by Browning-Ferris Industries of Rockford, Inc.from January 1971 to September 15, 1973. It is suspectedthat industrial wastes we.re deposited subsequent to 1965.Information ""gathered during "an IEPA Survey indicated thatthe landfill waste materials vary from 18 to 23 feet inthickness. Inspections by the Illinois EPA report that thelandfill was operating in compliance up until 1970. Afterthis time, numerous violations were sited including:unconfined dumping, inadequate spreading and compacting,blowing litter, stock piling and burning of trees and brush,poor roads, over-filling the site, improper unloading, nosanitary facilities or equipment building, no accessrestrictions, smoldering underground fires (9/71 and 3/73),and leachate flows.

Special wastes deposited into the landfill include sewagesludge from the City of Belvidere Sewage Treatment Plan andpaint/oil sludges from the Belvidere Chrysler Plant whichbegan operation in 1964. In 1971, 100 tons of waste per daywere being deposited even though the Solid Waste DisposalPermit Application by the City of Belvidere indicated that52 tons of waste per day were to be deposited at thelandfill. A hydrogeologic investigation by the IEPA hasreconstructed the development of the Belvidere/Municipal #1Landfill using aerial photographs. The area of most concernis the area of the landfill that was operating from1967-1974. This affected approximately 3.8 acres at thewestern most edge of the actual landfill. Figure 1-3 showsthe suspected location of hazardous waste disposal at thelandfill.

1.3 CHEMICAL HAZARDS

There have been two studies to date on the site. In 1978,the IEPA installed three leachate wells and 10 groundwater

-N-

APPROXIMATECUMULATIVE

SYBMOL PERIOD ACREAGE

1 * fr * » » ' •« . « * . • • « •

I* * * ^ .fc • * * *

^»*

fr^v.i

illiiil

W®§K

PRE-1945 0.4

1944-1955 3.4

1955-1960 5.4

1960-1967 7.5

19671974 113

JO 5001 , , , , 1

SCALE IN FEET

——•—• — •— 1967 BORROW AREA

_.._..._......„..._ 1974 BORROW AREA

SOURCE: IEPA. 1961

FIGURE 1-3SUSPECTED LOCATION OF

HAZARDOUS WASTE DISPOSAL

Belvidere Health and Safety PlanNovember 7, 1985Page No: 1-6

monitoring wells. Results of analyses of leachate,groundwater, and surface water from 1978 through 1980 arepresented in Appendix A.

Additional data was presented by CH2M Hill in 1984,specifically information concerning organic concentration.This data is also included in Appendix A.

Based on well water analyses and types of wastes disposed ofat the site, the hazards associated with inorganic andorganic constituents are discussed in chemical data sheetsincluded in Appendix B as attachments to the Work LocationPersonnel Protection and Safety Evaluation Form (WLPPSEF).

1.4 DESCRIPTION OF PROJECTED SITE ACTIVITIES

Projected activities within the Remedial Investigation willbe implemented in three phases commencing in November 1985and extending into November 1986. Initial on-site work willinclude development of three detailed maps.

The first active on-site data gathering effort will begeophysical studies undertaken through the coordinatedefforts of the IEPA and WESTON. Objectives of thegeophysical studies are multiple with the primary emphasisto evaluate site stratigraphy, depth to bedrock, volume andextent of the landfill, and to determine the extent ofgroundwater contamination.

Following completion of the geophysical surveys, review ofthe data and plotting of subsurface materials, the RI phasewill shift to waste characterization and qualification andsite investigation. The site investigation methods willinclude the sampling and analyses from the following media:

o Groundwater in 26 newly installed stainless steelgroundwater monitoring wells

o Drinking water in 10 private water supply wells

o River water and sediment

o Leachate and stained surface soil

o Pond water and sediment

o Fish and invertebrates

1.5 SITE HEALTH AND SAFETY RESPONSIBILITIES

The Site Health and Safety Coordinator and SafetyTechnician(s) have primary responsibility for .implementingand monitoring site health and safety related activities.

Belvidere Health and Safety PlanNovember 7, 1985Page No: 1-7

Site Health and Safety Coordinator (SHSC1

The SHSC is responsible for daily supervision anddocumentation of all safety, decontamination, environmentalmonitoring and field medical monitoring activities. TheSHSC is responsible for assuring that all field personnelcomply with the provisions of this HSP. The SHSC has theauthority to stop site work in the event of safetyviolations or if he/she makes the judgment that an upgradedlevel of personnel protection may be required. The SHSC hasthe ultimate responsibility to stop any operation thatthreatens the health or safety of the field investigationteam or surrounding populace. The SHSC is furtherresponsible for designating and marking restricted areasduring various site activities and for redesignating theseareas as unrestricted when it is appropriate to do so.

Safety Technician

A Safety Technician (ST) may be appointed full time or maybe designated by the SHSC on a part-time basis. The SafetyTechnician will aid the SHSC in supplies acquisition,inventory control, equipment maintenance, other health andsafety matters, decontamination activities, field medicalmonitoring and documentation. The Safety Technician willreport directly to the SHSC in health and safety relatedduties and will assume the responsibilities of the SHSC inthe event of his/her absence from the site or in anemergency situation involving the SHSC.

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-1

2.0 FIELD HEALTH AND SAFETY PROCEDURES

2.1 GENERAL WORK RULES

Field work will be conducted only during daylight hoursunless adequate lighting is provided. The "buddy11 systemwill be observed at all times when site personnel arerequired to wear respiratory protection.

Entry and exit into the continuous work area, exclusionzones, and contamination reduction zone will be permittedonly through designated access points, except during anemergency or as authorized by the SHSC. Personnel enteringthe exclusion zone must be wearing the required minimumprotective clothing as specified in Section 2.4 and theymust exit these areas via the Decontamination Station.

Eating, drinking, chewing gum or tabacco, smoking, or anypractice that increases the probability of hand-to-mouthtransfer and ingestion of material is prohibited 'in any areadesignated contaminated. Contact lenses may not be worn inexclusion zones. All field personnel requiring correctivelenses must provide their own prescription glasses andlenses that may be fitted in to the respiratory masks.

Hands and face must be thoroughly washed upon leaving thework area and before eating, drinking, or any otheractivities. The entire body should be thoroughly washed assoon as possible after leaving the site.

No excessive facial hair, which interferes with asatisfactory fit of the mask-to-face seal, is allowed onpersonnel required to wear respiratory protective equipment.The SHSC will determine if facial hair presents such aninterference.

Contact with contaminated or suspected contaminated surfacesshould be avoided. Personnel will be instructed not to walkthrough puddles, mud, and other discolored surfaces; kneelon ground; lean, sit, or place equipment on drums,containers, vehicles, or the ground whenever possible.

All personnel assigned for on-site activities must beadequately trained and thoroughly briefed on anticipatedhazards, equipment to be worn, safety practices to befollowed, emergency procedures, and communications.

All field activities will comply with OSHA 29CFR1926/1910Safety and Health Standards for the Constructive Industry.Frequent and regular inspections of the site, materials andequipment will be made by a competent person to verifycompliance with Subpart C (29CFR1926.20) General Safety andHealth Provisions. In addition, all electrical

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-2

installations shall be in accordance with the NationalElectrical Code (NEC, NFPA 70) and with OSHA 29CFR1926.400Subpart K.

2.2 HEALTH. SAFETY AND MEDICAL MONITORING PROGRAMS

All personnel including subcontractors who will be workingat the Belvidere site must conform to WESTON health andsafety policy which requires satisfactory completion ofhealth and safety training and be enrolled in a medicalmonitoring program.

The health and safety training program provides informationand training necessary for project personnel to undertakeactivities at uncontrolled hazardous waste sites. Thisinformation is generally provided in the WESTON five daytraining courses.

The intent of medical monitoring program is to monitor thehealth of individual project personnel through the use ofpreplacement and periodic medical examination. This programprovides:

o Establishment of a baseline condition againstwhich any future changes in health and physicalwell being can be evaluated.

o Identify any underlying illness or conditionswhich might be aggravated by certain exposures atthe job site.

o Recognize any abnormalities, toxic reactions orother changes at the earliest opportunity so thatappropriate corrective measures may be taken.

2.3 WORK ZONE DEFINITION

The Belvidere landfill site may be broadly classified as aLevel D or C site depending upon the field activity withcontingency to both up and downgrade level of protectiondepending upon the site activity and real time monitoringdata. The site boundary will serve as the "hot line" andthereby define the exclusion zone.

The site will have three distinct working zones — theexclusion zone, contaminant reduction zone and support zone.The decontamination station will include facilities forpersonnel and sampling equipment decontamination and agravel washdown pad for decontamination of drilling rig andother contaminated vehicles. These are further discussed inSection 2.5.

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-3

2.3.1 Exclusion Zone

The entire area within the Belvidere landfill site boundary(Figure 2-1) will be considered the exclusion zone.Movement into or out of the exclusion zone by personnel andequipment will be strictly controlled by SHSC. Personnelentering this zone will wear protective equipment asdiscussed in Section 2.4. Personnel and equipment exitingthis zone must be decontaminated in accordance with theprocedures described in Section 2.5. Drill cuttings andgroundwater accumulated during drilling and groundwatersampling activities will be left adjacent to the borehole.

2.3.2 Contaminant Reduction Zone

A contaminant reduction zone will be provided adjacent tothe exclusion zone and provides transition between exclusionand support zones. Decontamination of personnel andequipment exiting the exclusion zone will be performed inthis area as shown in Figure 2-2 prior to entering thesupport zone. Entering the support zone will requireremoval of any protective equipment worn in thecontamination reduction zone.

2.3.3 Support Zone

The support zone is considered a non-contaminated or cleanarea outside and adjacent to the contamination reductionzone as shown in Figure 2-1. All support equipment arelocated in this zone. Normal work clothes are appropriatefor this zone and for this reason contaminated clothing andequipment are not permitted in this zone.

2.4 PERSONNEL PROTECTION PROCEDURES

Personnel protection procedures are established in the HSPto ensure that all field personnel wear the necessaryprotective equipment to minimize exposure to thecontaminants present at the site. This section discusses indetail the anticipated levels of protection and thenecessary equipment to be worn by field personnel forvarious field activities.

2.4.1 Levels of Protection

Levels of protection to be used for the Belvidere landfillsite varies depending upon the nature of field activities.The levels of protection for various site activities aresummarized in Table 2-1. The levels of protectionidentified in Table 2-1 is based on the current knowledge ofthe waste types disposed of at the site. For each activity,a contingency level of protection is provided to upgrade the

SUPPORT ZONE

N-Iill 111 iTl i IT

0I I . .SCALE IN FEET

SECTION BOUNDARY

GRAVEL PIT BOUNDARY

PROPERTY BOUNDARY

LANDFILL BOUNDARY

WASTE DISPOSAL BOUNOAR

WOODS

EXCLUSION ZONE BOUNDA

SITE A C C E S S ROAD

"5URCE: IEPA. 1981FIGURE 2-1

WORK ZONE MAP

Wash Basin

O Sprayer

^^ Glove Tree

O Pail

Tyvex Peg-Rack

O Trnh Can O TrsthCan

D OTraehCan

OuterBootRemoval

ContaminationControl Line

OuterGlove Washand Removal

Boot Wash Tyvex InnerGlovo HandWathand Rlnee Removal Removal and Rlnee

FIGURE 2-2 PERSONNEL DECONTAMINATION LINE

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-6

TABLE 2-1

Levels of protection for Various Field Activities

Activity Description Level of Protection Contingency1

Grid Layout D D

Geophysical Survey D D

Monitoring Well D CInstallation

Waste and Natural Soil D CBoring Sampling

Pond Sediment Sampling D C

Leachate Seep and Sediment D CSampling

Groundvater and Pond Water D CSampling

River Water and Sediment D DSampling

Fish and Invertebrate Sampling D C

Private Well Sampling D D

1 Upgrading levels of protection is based on field monitoring.

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-7

existing level of protection based on field monitoring data.The level of protection may be downgraded by SHSC afterdiscussion with the WESTON Corporate Health and SafetyOfficer or Project Manager. As shown in Table 2-1 Level Aor B protection is not anticipated for any field activitiesassociated with this site. The probable locations forvarious field sampling activities are shown in Figure 2-1.

The criteria that will be used for determining the level ofprotection and the associated equipment needs are discussedbelow.

Level D

Level D protection will be used during geophysical surveys,river water/sediment and private well sampling. Level Dprotection will also be initially used during monitoringwell installation, pond sediment/water, natural soil boring,waste boring, leachate seep and sediment sampling, andground water sampling (with provision to upgrade to Level Cif warranted). Level D is also the minimum protection levelfor safety technician assisting in decontaminationoperation. Level D protective clothing should be taped atthe wrists and ankles.

The criteria and equipment required for Level D protectionis presented in Table 2-2.

Level C

The contingency to upgrade the level of protection from D toC has been provided for various field activities asidentified in Table 2-1. Level C protective clothing shouldbe taped at the wrists and ankles.

The criteria and equipment required for Level C protectionare presented in Table 2-3.

2.4.2 On-Site Medical Monitoring

On-site medical monitoring will be implemented by SHSC inthe event that hot or cold weather poses a threat of heatstress or hypothermia. Such monitoring will includemeasurement of pulse, blood pressure and temperature. Pulseand blood pressure will be monitored by a portable meterwith digital readout. This will be done prior tocommencement of work and prior to rest periods. Temperaturewill also be taken at the same time pulse and blood pressureare taken. The purpose of this monitoring is to ensure thatproject personnel are not unduly affected by workingconditions at the site. These measurements serve to detect

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-8

TABLE 2-2

Criteria for Selection and Personnel Protective EquipmentFor Level D

Criteria for Selection

When the Type(s) and Concen- a.tration(s) of hazardous sub-stances are known, and require b.no respiratory protection,skin and eye protection. Theseconditions are: c.

1) Atmospheres with concen-trations of substances d.less than the TLV or PEL

2) Atmospheres with greaterthan 19.5% oxygen

3) Type(s) and concentration(s) e.of vapors in air do notpresent a cutaneous or per-cutaneous hazard to the skin f.

A determination is made thatactivities preclude exposure tobody parts.

Total vapor readings indicate back-ground conditions.

Protective Equipment Required

Cotton coveralls

Tyvek coveralls, coated ornoncoated

Safety glasses(monogoggles)

Steel toe/shank boots,neoprene, or steel toe/shank safety boots,leather, with neopreneoverboots

Hard hat (in areas of over-head hazard)

Inner and outer gloves(Innerpolyethylene; Outer -Neoprene) when required bySHSC

Belvidera Health and Safety PlanNovember 7, 1985Page No: 2-9

c.

TABLE 2-3

Criteria for Selection and Personnel Protective Equipmentfor Level C

Criteria for Selection

When the type(s) and concen-tration (s) of hazardoussubstances are known, andrequire a lower degree ofrespiratory protection aswell as a lower level ofskin and eye protection.These conditions are:

1) Atmospheres with concen-trations of known sub-stances less than pro-tection factors associatedwith full-face air-purifyingrespirators

2) Atmospheres with greaterthan 19.5 percent oxygen

3) Type(s) and concentration(s)of vapors in air do notpresent a cutaneous or per-cutaneous hazard to small,unprotected areas of thebody.

A determination is made that potentialexposure to the body parts notprotected by a hooded suit is highlyunlikely. These conditions are:

1) Known absence of cutaneous orpercutaneous hazards.

2) Activities preclude splashing ofindividuals.

Total vapor readings indicate lessthan 5 ppm above background. Atmos-phere does not contain high levels oftoxic substances affecting skin or eyes.

Protective Equipment Required

a. Full-face, air-purifyingrespirator (MSA Ultra-twin)

b. GMC-H cartridges

c. Cotton coveralls

d. Tyvek coverall, coated ornoncoated (determined by SHSC)

e. Steel toe/shank safety boots,neoprene or, steel toe/shanksafety boots, leather, withneoprene overboots (Tyndall)

f. Hard hat

g. Inner and outer glove (Inner-Polyethylene; Outer - Neoprene)

Balvidere Health and Safety PlanNovember 7, 1985Page No: 2-10

any harmful effects due to heat stress as well as effectsdue to working in cold weather. The basic purpose of heatstress monitoring and effects of heat stress and effects ofexposure to cold weather are presented in Appendix C. Thisinformation is taken from the "Interim Standard OperatingSafety Guides" revised in 1982 and prepared by the Office ofEmergency and Remedial Response, Hazardous Response SupportDivision.

2.5 DECONTAMINATION PROCEDURES

Proper decontamination of all personnel, sampling equipmentand vehicles that are exposed to any form of contaminationwhile working at the site is required. To ensure this,decontamination facilities will be set up on thecontamination reduction zone between the exclusion andsupport zones. The decontamination facility for vehicleswill consist of a gravel pad located adjacent to thepersonnel and sampling decontamination facility.

2.5.1 Personnel and Sampling Equipment

The personnel decontamination line is illustrated in Figure2-2 and includes outer boot removal, outer glove wash andremoval, and hand wash steps. All disposable safety gearwill be placed in drums upon removal. Drums will besecurely closed when filled and placed in a locked BooneCounty Conservation District storage garage. Thesematerials will be temporarily stored and subsequentlydisposed of in an acceptable manner. Detergent will be usedfor washing of boots, outer glove and hands. Thedecontamination line shown in Figure 2-2 is illustrated forLevel D protection and can easily be upgraded for higherlevels by adding a step for respirator removal prior toinner glove removal.

The equipment decontamination process is illustrated inFigure 2-3 and will be used for decontamination of pumpsused in monitoring well development, Teflon bailers used inmonitoring well sampling, equipment used to collect surfacewater and sediment samples, and the hand auger used in soilsampling. This decontamination facility will be locatedcontiguous to the personnel decontamination line. Largemetallic wash tubs will be used for the detergent was and tapwater rinse steps. Stainless steel, solvent-resistantsprayers will be used for the acetone, distilled-deionizedwater, and ultra pure (organic-free) water rinses. Theacetone sprayer will be properly marked with a "FlammableLiquid - No Smoking" warning sign. The acetone rinse andwater rinses will be collected in separate metallic tubs.

Cold

HoT

Tent

ConuMNfwttonControl Uno

Note: Electrical space healers needed If amWenftemperatures are at or below freeiing

FIGURE 2-3 SAMPLING EQUIPMENT DECONTAMINATION STATION

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-12

If freezing temperatures are encountered, electric spaceheaters will be used to prevent freeze-up of decontaminationequipment and solutions, and cleaned sampling equipment.

2.5.2 Vehicle

The drilling rig and other contaminated vehicles will bedecontaminated on a gravel washdown pad. The pad will beapproximately 30 square feet in area. The equipment will besteam cleaned using rented portable steam cleaningequipment.

2.6 AIR MONITORING PROCEDURES AND RESPONSE

Air monitoring will be conducted utilizing a variety oftechniques to assure adequate protection to personnelinvolved in various field activities. As a minimum, thefollowing monitoring equipment will be used at the Belvideresite:

HNu Photoionizer 10.2 ev probeHNu Photoionizer with 10.2 ev sourceHNu Calibration Gas RegulatorLudlum Radiological Survey Meter (Model 3)

M44-3 Lo Energy GAM ScinM44-6 Thinwass GM ProbeM44-9 Pancake GM Probe

Organic Vapor Analyzer (Century) and Calibration GasCombustible Gas Indicator/02 Meter

The principal air monitoring instrument will be an HNu P-101photoionization detector (PID). The PID will be calibrateddaily in accordance with the manufacturer's recommendedprocedures before use. The HNu meter will be employedduring all on-site work activities with particular emphasisapplied during the drilling activities. If deemednecessary, the SHSC will also implement monitoring oforganic gases and vapors using organic vapor analyzer (OVA)in the survey and if appropriate in gas chromatography mode.

Prior to the start of field activities, the SHSC will scanthe entire site with oxygen meter and combustible gasindicator (OGI) to determine whether any areas of the sitehave the potential to have oxygen deficient conditions orpresence of combustible gases. In addition, scan of theentire site using a radiation meter will also be made todetermine the presence of radioactive materials.Measurements for oxygen deficiency, presence of combustiblegas and radioactive materials will also be done duringmonitoring well installation and waste and soil sampling.The guidelines that will be used for employing proper levelsof protection in response to air monitoring data arepresented in Table 2-4.

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-13

TABLE 2-4

Atmospheric Hazard Guidelines

Monitoring Equipment Hazard

Combustible gasindicator

Explosive < 10% LELAtmosphere

10%-25%

Oxygen concentration Oxygenmeter

> 25% LEL

< 19.5%

19.5%-25%

> 25.0%

Action

Continue invest-igation

Continue on-sitemonitoring withextreme cautionas higher levelsare encountered

Explosion hazard;withdraw fromarea immediately.

Monitor wearing•SCBA. NOTE;Combustible gasreadings are notvalid in atmos-pheres with19.5% oxygen.

Continue investi-gation withcaution. SCBAnot needed, basedon oxygen contentonly.

Discontinueinspection; firehazard potential.Consultspecialist.

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-14

TABLE 2-4(Continued)

Radiation survey Radiation < 1 mR/hr Continue investi-gation. Ifradiation is de-tected abovebackgroundlevels, thissignifies thepresence ofpossibleradiationsources; at thislevel, morethoroughmonitoring isadvisable.Consult with ahealth physicist.

Monitoring Equipment Hazard Ambient Level Action

Radiation Survey Radiation > 10 mR/hr Potentialradiation hazard;evacuate site.Continue monit-oring only uponthe advice of ahealth physicist.

HNu/OVA Organic Background Level DVapors 0-5 ppm above background Level C

5-500 ppm above background Level B500-1000 ppm above back- Level Aground

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-15

The personnel protective equipment that will be used forvarious field activities are included in the WLPPSEF(Appendix B).

2.7 CONTINGENCY MEASURES

A contingency plan is required to handle any unforeseensituations that might occur at the site. These might resultfrom chemical exposure, physical injury andfire/explosion/release of toxic gases. The SHSC will set upa prearranged warning signal (e.g. hand held compressed gashorn) for use in emergency situations. Portable radios willalso be used by field personnel so that SHSC can alert fieldpersonnel immediately of impending or actually occurringemergency conditions. Emergency phone numbers are listed inpage 12 of the WLPPSEF (Appendix B) which includes fire andpolice department, ambulance service, State spillContractor, Region V EPA Environmental Response Team, U.S.Coast Guard and CHEMTREC.

All of the emergency phone numbers will be posted. Theroute to the hospital in the event any field personnel mustbe taken to the local hospital is shown in Figure 2-4. Thisroute map will also be posted. The route will be driven byall site personnel prior to initial site entry.

The response to various emergency situations are discussedin the following subsections.

2.7.1 Chemical Exposure

The SHSC will take the following actions if chemicalexposure results during on-site field activities:

a. Immediate assessment shall be made as to what typeof safety gear is necessary to enter the area todetermine how ill or injured the victim is.

b. Rescuers must check vital signs.

c. Remove victim to fresh air and resuscitate ifnecessary.

d. An ambulance will immediately be called.

e. If clothing is contaminated and the situationpermits, remove clothing and flood skin withcopious amounts of water.

f. If eyes are contaminated, irrigate immediatelywith copious amount of water for minimum of 15minutes.

. / - \ h i p /• .~ir~"-i'; • •

V.er_,B E L V I . D E R \ IE

k-T^.v. . *&£ vp->s/-Tr;^ r"^r-~rf--1' «-^-X>Tr " - f . • . •-* - - - . - . i -s =. - i - =- - - r- *, V. ••! C * m - )•- •*% ^»* *LjfcjfflSf..*".. ^ • | X. lN : j.- -— ... u • !-• 4* . -r

'-.> O o. x^ ^ T;~ '

r-s^2l_ii:a«s fl Lsa 11

FIGURE 2-4ROUTE TO HOSPITAL

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-17

g. Have patient transported to the hospital andnotify hospital.

2.7.2 Physical Injury

In case field personnel are injured during any fieldactivities, SHSC will administer appropriate first aidprocedures. A list of first aid equipment that will be kepton-site is presented in Table 2-5. Two portable eyewashunits will be kept within close proximity to monitoring wellinstallations and waste/soil boring activities.

The following action will be taken in case of physicalinjury:

a. For minor injuries, routine first aid procedureswill be used.

b. For major injuries, an ambulance will immediatelybe called. Aides will get information about thenature of the injury .from the victim if the victimis conscious.

c. If the victim is unconscious, the first aiderswill check for vital signs.

d. In the event of cessation of breathing and/orcessation of heartbeat, appropriately trained(qualified) first aiders will administercardiopulmonary resuscitation.

e. In the event of bleeding, broken bones, shock,burns, heat exhaustion, heat stroke, seizure,insect sting, etc., the first aiders will use theRed Cross approved measures for treatment.

f. It should be noted that heat stroke is a medicalemergency and that the victim should be taken to ahospital immediately.

g. In the event that the injury is less serious butwarrants further medical attention, the victimshall be transported to the local hospital (St.Joseph Hospital).

2.7.3 Fire/Explosion/Release of Toxic Gas

In case fire/release of toxic gases result during any fieldactivities, the SHSC will implement the following:

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-18

TABLE 2-5

LIST OF FIRST AID EQUIPMENT

American National Red Cross First Aid HandbookCompressesGauze & Gauze roller bandageTriangular bandagesEye dressing packetSmelling saltsBaking sodaSalt or other emeticPortable eyewash unit (3)Oxygen bottles, valves, etc.Soap or waterless hand cleaner and towelsBack braceBand aidsTapeScissorsTweezersRazorsStretcher

Belvidere Health and Safety PlanNovember 7, 1985Page No: 2-19

Localized Fire

a. Move all people in the area upwind to a safedistance.

b. Notify local fire department.

c. Decide whether or not it would be advisable toattempt initial fighting of the fire.

d. If deemed advisable to attempt fighting of fire,use the most appropriate means.

e. Advise and direct the Fire Department ifrequested, e.g., with dire moving.

Uncontrolled Fire Releasing Toxic Gases

a. Notify the police, The police will notify allpossible downwind entities that will be affected.

b. Stand by to assist the Fire Department withinformation about the nature of the material onfire, the nature of the toxic gases.

c. Immediately notify the State and U.S. EPA

d. Render first aid to anyone needing it.

Belvidere Health and Safety PlanNovember 7, 1985Page No: 3-1

3.0 DOCUMENTATION

Implementation of the provision of this Health and SafetyPlan must be completely documented. The SHSC should set up aseparate file to receive health and safety records andactivity reports. The file should contain the followingrecords:

1. Site Clearance Work Sheet form (Appendix D) toensure that personnel assigned for fieldactivities have the necessary medicalqualifications and have tested for fitness to wearrespiratory equipment.

2. Copies of Page 14 of the WLPPSEF documentinghealth and safety briefings and personnelsignatures.

3. Environmental monitoring activities and results.

4. Equipment calibration and maintenance records.

5. Copies of safety equipment operation manuals.

6. Site activity log (Appendix D).

7. Exposure Input Form and Monthly Exposure/InjuryReport (Appendix D).

8. Other pertinent health and safety relatedobservations.

All field personnel must sign page 14 of the Work LocationPersonnel Protection and Safety Evaluation Form (AppendixB) indicting that they have attended a briefing by the SHSC,understand and agree to abide by the,provisions of this HSP,prior to working at the Belvidere Landfill site.

Belvidere Health and Safety PlanNovember 7, 1985Page No: 4-1

4.0 TOXICOLOGICAL PROPERTIES ANDHANDLING PROCEDURES OF KNOWN CONTAMINANTS

The chemical, physical, and toxicological properties ofamnonia, boron, cadmium, chromium, copper, cyanide, iron,lead, manganese, phenolics, phosphorous, PCB, toluene,xVlene, napthalene, methylnapthalene, trichlorebiphenyl,phthalater, 1,3 dichlorobenxene, benzene, ethylbenzene,diethyl phthalate, and Di-n-butyl phthalate are presented inAppendix B as an attachment to the Site Personnel Protectionand Safety Evaluation Form. This attachment also listsrecommended personnel protective equipment, first aidprocedures, and emergency material handling procedures.

SURFACE WATER TEST RESULTS

Parameters(ppa)

AlkalinityAmmonia, aa HArsenicBariuoiBODBoronCadaivnCalcluaCOOChlorideChromium (total)CopperCyanideFluorideHardnessIronLeadMagnesiumManganeseMercuryNickelNitrace-NitriteOil & GreasepH (units)PhenolicsPhosphorusPotassiiaiR.O.E.SeleniumSilverSodiumSC (umhos/ca)SulfateSulfideZinc

S101

340.0.210.0000.14.0.20.00

111.920.37.0.000.010.0000.17

460.0.90.00

48.00.170.00050.03.30.8.10.0000.142.1

708.0.0000.00

15.0789.

79.0.0000.0

River

S201

330.0.210.0000.13.0.10.00

105.316.36.0.000.000.0000.19

450.0.30.00

46.00.180.00000.03.50.8.40.0000.122.0

600.0.0000.00

16.0776.83.0.00000.0

S301

330.0.190.0000.13.0.10.00

102.616.36.0.000.000.0000.19

440.0.30.00

46.00.060.00000.03.70.8.50.0000.121.9

594.0.0000.00

16.765.83.0.00000.0

Pond

SS01

240.0.080.0000.1

<2.0.10.00

63.912.18.0.000.000.0000.09

300.0.00.00

37.00.090.00000.03.30.8.30.0000.012.0

400.0.0000.007.

546.49.0.00000.0

SS02

0.030.0000.13.0.10.00

64.312.18.0.000.000.0000.09

0.10.00

36.0.000.00000.03.30.8.30.0000.001.9

385.0.0000.007.

549.49.0.00000.0

Source: IEPA, 1981, "A Hydrogeologic Investigation ofthe Belvidere/Municipal * 1 Landfill."

Note: 1) All samples collected 1/8/80.2) R.O.E. » Residue on Evaporation

A-l

GROUNDWATER TEST RESULTS SUMMARY - INORGANICS

Far Malar a

(•••)

AlkalinityAaMMila. aa MAraaalcBarluBMO•or onCa4aiu»Calclta*COOChlorta-aChroatlua (total)

Co»M>CyaaltfaHuerldaNartfMl*

> Iron

M ••••<Maa,n*alMBton |» oat aMercuryNickelNliraia-HltrltaOil 6 CraaaaaH (u*lta)rtwuollca•toapliocutFotaialuBa.o.i.««SalanlMJIUarSo4iu»tC (u»hoa/ca>)tulfataSulllaeline

C110*

110.

0.06

O.OOO0.2

<4.0.1

<0.005100.16.25.<0.050.022*0.02

0.2190.

l.lft*<0.0141.0.16*0.0000

<0. 01a. 40.

•.0-8.40.0000.01

2. a496.<Q.OOS

0.00a.>

594.

49.0.0.02

C104

(250.)0.12

0.0000.2

54.o.a

(0.00)IOB.145.

(22.)(0.00)(0.02)0.01*

(0.1)410.

(0.1)(0.00)48.0.44*0.0000

(0.0)(0.8)0.

B.V8. 6o.ooa*0.011.4

672.*0.0010.00

14.791.

250.

0.00040.2

C107

550.

15.00*0.0110.42

19.1.1*

<0.0222«.

59.45.*0.1

"(0.005)(0.00)0.2

490.

19.9*"0.0576.5

0.74*0.0000

"0.05(0.0)

-

7.5-a.70.021*0.11*

15.5

610.*(0.00)"0,00540.

• 14.52.1.60.254

cioa

110.

1.10.0000.2

<16.0.1

(0.00)(78.)

OI.)12.(0.00)(0.01)(0.00)0.2

(160.)(0.2)(0.00)

(40.)0.2H

0.0000(0.0)(o.a)0.

7.9-8.60.0000.0]

l.«(416.)

(0.00)0.00

21.9

651.

56.0.

(0.0)

Uall

C109

570.

2.7*

0.0150.6

<16.

1.5*

(0.00)128.

20.49.(0.00)(0.00)(0.00)0.?

550.

(1.1*)(0.00)56.0.79*O.OOOO

(0.0)(0.2)0.

• .1-1.70.0000.04

9.1702.*(0.00)0.00

44.•45.

(19.)1.2

(0.0)

nuaibar

cm

750.

14.0*0.0160.5

<16.

1.7*

"0.005117.

51.120.

"0.05(0.005)(0.00)0.2

5W.14.1*"0.0176.0.12*O.OOOO0.006

(6.9)1.*

7.8-8.50.009*0.42*

ai.792.*(0.00)0.01*

aa. •1178.(M.)

2.0000(0.018)

C112

1400.57.0*0.019o.a

120.

5.0*

(0.00)152.

180.

210.

0.02

(0.00)(0.00)0.1

800.

25.1*0.02

112.

0.21*0.00000.1

(0.2)2.*

7.9-8.00.147*0.55*

ai.1440.*

(0.00)0.01*

212.2)M.

-2.00000.1

C201

(110.)(0.00)0.000

(0.0)(2.)(0.0)(0.00)

(92.)(8.)

42.(0.00)0. 17*

(0.0000)(0.10)

400.

(0.2)(0.00)41.(0.01)O.OOOO

(0.0)(7.0)1.*a. i0.000

(0.00)(2 .7)

522.*(0.000)0.00

20.682.

49.0.00000.5

C202

-(0.00)O.OOO

(0. 11"(I.)

(0.0)(0.00)

(97.)(4.)46.(0.00)0.07*

(0.000)(0.09)

-(0.2)(0.00)41.(0.00)

O.OOOO(0.0)(6.1)0.8.2O.OOO

(0.00)(2.4)

580.*(0.000)0.00

15.657.

61.0.00000.4

WjtarQualifyStanJarda

.

1.40.051.0-

1.00.01--

250.

0.05

0.02

0.0251.4-

1.00.05-

0.15

0.00051.0

10.0.1

6.5-9.0O.O010.05-

400.

0.01

0.005--

250.

-

• Nc*>lt«rl»B w«ll C1IO la (te u»(r aslant well. whiU tt* othara ara 4o*mtr«4t«nt.• Da«At«a co*caac.ratloaa akova ltw water quality ala»4ar4a.ODaaotaa concaatratloaa k»l«* th« ufgr**l«Bt lavala.

••R.O.E = Residue on Evaporation

Source: IEPA, 1981, "A llydrogeologic Investigation of the Belvidere/Municipal 11 Landfil l

GROUNDWATER TEST RESULTS SUMMARY—ORGAN ICS

Sample Point

G-110

G-104

G-107

G-108

G-lll

G-112

DateSampled

11-9-81

11-9-81

11-9-81

11-9-81

11-9-81

11-9-81

Organic Contaminant (ppb)

None detected

PCB's--<0.1Xylenes—240

PCB's—<0.1Xylenes—10,000C^-substituted benzenes—2,400MSthylstyrene—75

PCB's—0.2Xylenes—320

PCB's—<0.1Xylenes—140

PCB's—<0.1Xylenes—10,000C--substituted benzenes—730Methylstyrene—50

Source: IEPA, 1981

A-3

LEACHATE TEST RESULTS SUMMARY—ORGANICS

Sample Point

L-302

DateSampled

11/9/81*

Leachate pool at NWedge of landfill

Leachate pool at NWedge of landfill

11-9-81*

3-23-82**

Organic Contaminant (ppb)

PCB's—120Toluene—6,400Xylenes—63/000C--substituted benzenes—4,200(^-substituted benzenes—900Nlphthalene—400Methylnaphthalene—300Trichlorobiphenyl—3,600Aliphatic hydrocarbons—8,900Phthalates—750Unidentified compounds—6,000

PCB's—14Toluene—20,000Xylenes—43,000( -substituted benzenes—3,000Naphthalene—100

Toluene—2,2351,3-dichlorobenzene—4Benzene—37Ethylbenzene—1,108Naphthalene—7Diethyl phthalate—32Di-n-butyl phthalate—7

*Source:**Source:

IEPA, 1981USEPA, 1982

A-4

Effluent standards

CONSTITUENT CONCENTRATION (mg/1)

Ammonia 3.0Arsenic (total) 0.2SBarium (total) 2.0BOD5 30.0Cadmium (total) 0.15Chromium (total hexavalent) 0.3Chromium (total trivalent) 1.0Copper (total) 1.0Cyanide 0.10Fluoride (total) 15.0Iron (total) 2.0Iron (dissolved) 0.5Lead (total) 0.1Manganese (total) 1.0Mercury (total) 0.0005Nickel (total) 1.0Oil (hexane solubles

or equivalent) 15.0pH (unit) 5-10Phenols 0.3Phosphorus 1.0Selenium (total) 1.0Silver 0.1Zinc (total) • 1.0Total Suspended Solids 15.0Total Dissolved Solids 3500.0

A-5

a<

QL

I

7-

6-

5-

4-

3-

2-

1-

'

O 1 5

o3

1

Ag0,1

CMn6

6

AsOi25

mKMl1q

BoZJO

6

8«o1O*»

BOD9O.O

6

?r«3

CdO.IS

4

q

i

CN0.1

4 2

ori

t*

Cr*«O.3

P4

1

6

CuIjO

O

d

7

oini

ok

0

.1o

0

7

2.i-r>

6

oi0

2

3

r>ri

3

5

o6i

O

7

«o0CM

1CMs

0

<0

2

oo1

TT

o6

2

8«o

i

8

o

oo6oo6

6

in

io>d

c<

m

F F« Hg Mn NH4 Ni P Pb pH Phe. ROE. Se ZnIB.O 2JO QjOOOS I.O 3.O I.O I.O O.I S-IO O.3 35OO I.O I.O

Number olSamplesthe Elfluenl

Standard

Range ofConcentration

(mg/l)O. iOo6

Effluent .Standard in A9

mo/I eicepi -°-'.pH —^

vD

Parameters (mg/l)

Results of chemical analyses of leachate samples

Summary of well water analyses in comparison to water quality standards and backgroundconcentrations (maximum concentrations from 1979 and 1980 are indicated in mg/1).

faraattter*

<PP»>

AlkalinityAamoala. e* HAraentcBarlia*BOOBoronCad.ltaiCalcltMCOOChlorideChio»it** (total)CooperCyanide

1 Fluoride-^ Hardnea*

IronLa*dHa|,ne*l«aiHae>*eje*nNercuryNickelnitrate-NitriteOil 4 CreatepH (uolta)rb***)lc*Fhoaphoruafotaialu*K.O.I.Sele*lM> .

SilverSodllM

SC (uahoa/c*>>SulfateSuUldelie*

C110*

310.0.060.0000.2

<4.0.1

<O.OOS100.16.2i.<0.050.022*0.020.2

190.3.31+

<0.0l41.

0.16+0.0000

<0.01a. 40.

• A A A. O-0. %0.0000.012. a

4*6.<O.OOJ

0.008.5

3*4.49.0.0.02

C104

(2SO.)0.120.0000.2

S4.0.8

(0.00)108.145.(22.)(0.00)(0.02)0.01+

(0.1)430.(0.1)(0.00)48.0.44+0.0000

(0.0)(0.8)0.

• ^ • &. 3-B.60.004+0.013.4

472. +0.0030.00

16.791.250.

0.00040.2

C107

550. -15.00+0.0110.42

19.1.1+

<0.02228.59.45.<0.1*(0.005)

(0.00)0.2

490.39.9+<0.0576.50.74+0.0000

"0.05(0.0)

7 C • T. j-o. /0.023+0.11+

15.5610. +

(0.00)<0.00540.

814.52.1.60.254

0108

330.1.10.0000.2

<16.0.3

(0.00)(78.)(12.)32.(0.00)(0.01)(0.00)0.2

(360.)(0.2)(0.00)

(40.)0.23+0.0000

(0.0)(o.a)0.

7 Q_* ^• T-5.O

0.0000.033.8

(416.)(0.00)0.00

21.9651.56.0.

(0.0)

Well

C109

570.2.7+0.0150.6

<16.1.5+

(0.00)128.20.49.(0.00)(0.00)(0.00)0.2

550.(3.9+)(0.00)56.0.79+0.0000

(0.0)(0.2)0.

8 1 B 1. i -B.70.0000.049.1

702. +(0.00)0.00

44.84S.(39.)

1.2(0.0)

nimber

cm

750.14.0+

0.0160.5

<16.1.7+

«0.005112.51.

120.<0.05(0.005)(0.00)0.2

510.14.3+<0.0176.0.32+0.00000.006

(6.9)1.+

7 n _ e . ^« 0*0. j0.009+0.42+

ai.792.+(0.00)0.01+

aa.1178.

(36.)2.0000

(0.018)

C112

1400.57.0+0.0190.8

120.5.0+

(0.00)152.180.230.

0.02(0.00)(0.00)0.3

800.25.1+0.02

132.0.21+0.00000.1

(0.2)2.+

7 m • A. y""O. V

0.147+O.Ji+

83.1440. +

(0.00)0.01+

212.2586,

-2.00000.1

C201

(110.)(0.00)0.000

(0.0)(2.)(0.0)(0.00)

(92.)(8.)42.(0.00)0.17+

(0.0000)(0.10)

400.(0.2)(0.00)41.(0.01)0.0000

(0.0)(7.0)1.+a 30.000

(0.00)(2.7)

J22.+(0.000)0.00

20.682.49.0.00000.5

C202_

(0.00)0.000

(0.1)«(2.)

(0.0)(0.00)

(97.)(4.)46.(0.00)0.07*

(0.000)(0.09)

-(0.2)(0.00)43.(0.00)0.0000

(0.0)(6.3)0.a ^. t0.000

(0.00)(2.4)

5«0. +(0.000)0.00

15.657.61.0.00000.4

WaterQual ItyStandards_

1.50.051.0-

1.00.01--

250.0.050.020.0251.4-

1.00.05-

0.15 (0.00051.0

10.0.1

« • A M• >*».o0.0010.05-

500.0.010.005--

250..-$•

• Nocltorlaa. trail C110 !• the upiradleot veil, while the othere ere downtradlent.+ Denote* concentration* above the water quality etandard*.OOenotet concentration* below the upfradlenc level*. ('

APPENDIX B

WORK LOCATION PERSONNEL PROTECTION

AND SAFETY EVALUATION FORM

WORK LOCATION PERSONNEL PROTECTIONAND SAFETY EVALUATION FORM

Attach Pertinent Documents/Data

Fill in Blanks As Appropriate

WO f 1104-02-01 Reviewed by_

Division DCMD Date

Office Bannockburn, II Approved by

Prepared by Daniel R. Malinowski Date

Date Nov. 6, 1985

A. Work Location Description

1. Name Belvidere Municipal Landfill #1 2. Location Adjacent to

Belvidere, II. Appleton Road, West of

' Belvidere, II.

3. Type: HW Site (x ) Industrial ( )

Spill ( ) Construction ( )

( x ) Existing WESTON Work Location

( ) Existing Client Work Location

Other ( ) Describe

4. Status Remedial investigation

5. Anticipated activities: Site Investigation

6. Size Total landfill property-139 acres/actual landfilling area-11 acres.

7. Surrounding Population Belvidere Population - 15176

8. Buildinqs/Homes/Industry Buildings along Appleton Road.

Page 1 of 14

5435A B-l

9. Topog r aphy Relatively f la t - maximum elevation change is

approximately 25 feet .

10. Anticipated Weather Cold

11. Unusual Features None

12. Site History .Closed Municipal landfill that operated from 1939-1973.

Accepted industrial wastes from 1965 until closing. Type and quantity of

industrial waste is unknown.

B. Hazard Description

1. Background Review: Complete ( x ) Partial ( )

If partial, why?

2. Hazard Level: A ( ) B ( )

Unknown ( ) C ( ) D ( x )

Justification Low levels of contaminants

3. Types of Hazards: (Attach additional sheets as necessary)

A. Chemical ( x ) Inhalation ( ) Explosive ( )

Biological ( ) Ingestion ( ) 02 Def. ( )

Skin Contact( x ) Toxic ( )

Describe Contact with contaminated soils, groundwater, leachate;

exposure to cold.

B. Physical ( ) Cold Stress ( x )

Heat Stress ( )

Noise ( )

Other ( )

5435APage 2 of 14

B-2

Describe Field activities scheduled for winter.

C. Radiation ( )

Describe

4. Nature of Hazards:

Air ( ) Describe

Soil ( x ) Describe gfa- lnoH gi i r fara girlie havo hoon nhgorrr

Surface Water ( ) Describe

Groundwater ( ) Describe

Other ( x ) Describe Leachate leaving the landfill has been analyzed

and contains organic and inorganic constituents.

Page 3 of 14B-3

5435A

5. Chemical Contaminants of Concern N/A

InstrumentsTLV

Contaminant (PPM)

PCB 1 mg/ 3in

Toluene 100

Xylene 100

C -Substituted 10Benzenes

C -Substituted 10ft

Benzenes

Naphthalene 10•o

f-jMethylnaphthalene

*trichlorobiphenylo-n

Benzene 10

Ethylbenzene 100

I .D.L .H.(PPM)

10,000

2000

2000

500

2000

2000 .

Source/QuantityCharacterist ics

(PPM)0.1220.0 Leachate

43.0 Leachate

4.2

0.9

0.4

0.3

3.6

0.37

1.11

Route of Symptoms of Used to MonitorExposure Acute Exposure Contaminant

Inh.Abs, Ing, Con

Abe, Con

Inh.Abs, Ing, Con

Inh.Abs

Inh.Abs

Inh.Abs, Ing. Con

Ing, Con

Inh.Abs

Inh.Abs

AliphaticHydrocrocarbons 8.9

5435A

6. Physical Hazards of Concern ( )

Hazard Description

(u

1(0

in

O

5435A

LocationProcedures Usedto Monitor Hazard

7. Work Location Instrument Readings ( ) N/A

Location

% 02

Radioactivity

FID

Other

Location

Radioactivity_

FID

Other

Location_

% 02

Radioactivity_

FID

Other

Location_

* °2

Radioactivity_

FID

Other

% LEL

PID

Other_

Other

% LEL

PID

Other_

Other

LEL_

PID

Other_

Other

LEL_

PID

Other

Other

8. Hazards expected in preparation for work assignment. ( ) N/A

Describe:

Page 6 of 14B-6

C. Personnel Protective Equipment

1. Level of Protection

A ( ) B ( ) C ( )

Grid Layout

D ( x) Location/Activity:

( ) B ( ) C ( )

Grid Layout (contingency)

D (x) Location/Activity:

Protective Equipment (specify probable quantity required)

Respiratory ( )

( ) SCBA, Airline

N/A

( ) Full Face Respirator(Cart. _ )

( ) Escape Mask

( x) None

( ) Other_

( ) Other

Head & Eye C ) N/A

( ) Hard Hat

( ) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( x) None

( ) Other

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

(18) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify

( ) Other

( ) Other

Hand Protection ( ) N/A

(18) Undergloves CottonType

( ) GlovesType

(18) Overgloves RubberType

( ) None

( ) Other

Page 7 of 14

3.

Foot Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

Monitoring Equipment ( ) N/A

( ) CGI

( ) 02 Meter

( ) Rad Survey

( ) Detector Tubes

Type:

{ )

( > FID

( ) Other

( ) Other

D. Personnel Decontamination (Attach Diagram)

Required ( x ) * Not Required ( )•

Equipment Decontamination (Attach Diagram)

Required ( x ) ' Not Required ( )

If required, describe and list equipment

Disposable clothing will be placed in plastic bags and containerized on site.

5435A

Page 8 of 14

B-8

C. Personnel Protective Equipment

1. ( Level of Protection

A ( ) B ( ) C ( )

Geophysical Survey

D ( x) Location/Activity:

( ) B ( ) C ( ) D

Geophysical Survey (Contingency)

( x) Location/Activity:

2. Protective Equipment (specify probable quantity required)

Respiratory ( )

( ) SCBA, Airline

N/A

( ) Full Face Respirator(Cart. _ )

( ) Escape Mask

( x) None

( ) Other_

( ) Other

Head & Eye C ) N/A

( ) Hard Hat

( ) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( x) None

( ) Other '

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

( x) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify

( ) Other

( ) Other

Hand Protection ( ) N/A

(x ) Dndergloves CottonType

( ) GlovesType

(x ) Overgloves RubberType

( ) None

( ) Other

Page 7 of 14R-Q

Foot Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

3. Monitor ing Equipment ( ) N/A

( ) CGI ( )

( ') 02 Meter ( ) FID

( ) Rad Survey ( ) Other

( ) Detector Tubes • •

Type: ( ) Other

D. Personnel Decontamination (Attach Diagram)

Required ( x ) * Not Required ( )

Equipment Decontamination (Attach Diagram)

Required ( x ) Not Required ( )

If required, describe and list equipment*

Disposable clothing will be placed in plastic bags and containerized on site.

Page 8 of 14

5435A B'10

Foot Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

3. Monitoring Equipment ( ) N/A

( ) CGI ( )

( ) 02 Meter ( ) FID

( ) Rad Survey ( ) Other_

( ) Detector Tubes •

Type: ( ) Other

D. Personnel Decontamination (Attach Diagram)

Required ( x ) * Not Required ( )

Equipment Decontamination (Attach Diagram)

Required ( x ) Not Required ( )

If required, describe and list equipmentDisposable clothing will be placed in plastic bags and containerized on site.

Page 8 of 14B-12

5435A

C. Personnel Protective Equipment

1. Level of Protection

A ( ) B ( ) C ( )

Monitoring Well Installation

D ( x) Location/Activity:

A ( ) B ( ) C ( x ) D ( ) Location/Activity:

Monitoring Well Installation (Contingency)

2. Protective Equipment (specify probable quantity required)

Respiratory ( )

( ) SCBA, Airline

N / A

( x) Full Face Respirator(Cart. GMC-H )

( ) Escape Mask

( ) None

( ) Other.

( ) Other

Head & Eye C ) N/A

( x) Hard Rat

( ) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( ) None

( ) Other

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

(x ) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify

{ ) Other

( ) Other

Hand Protection ( ) N/A

(x ) Undergloves CottonType

( ) GlovesType

(x ) Overgloves RubberType

( ) None

{ ) Other

Page 7 of 14R-11

C. Personnel Protective Equipment

1. Level of Protection

A { ) B ( ) C ( ) D ( x ) Location/Activity:

Waste and Natural Soil Boring Sampling

A ( ) B ( ) C ( x ) D ( ) Location/Activity:

Waste and Natural Soil Boring Sampling (Contingency)

2. Protective Equipment (specify probable quantity required)

Respiratory ( )

( ) SCBA, Airl ine

N/A

( x) Full Face Respirator(Cart. GMC-H )

( ) Escape Mask

( ) None

( ) Other,

( ) Other

Head & Eye C ) N/A

( x) Hard Hat

( ) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( ) None

( ) Other

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

(x ) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify^

( ) Other

( ) Other

Hand Protection ( ) N/A

(x ) UnderglovesCottonType

( ) GlovesType

(x ) Overgloves Rubber

( ) None

Type

( ) Other

Page 7 of 14

Foot Protection ( ) N/A

( x) Safety Boots

(x ) Disposable Overboots

( ) Other

3. Moni tor ing Equipment ( ) N/A

( ) CGI ( )

( ) 02 Meter ( ) FID

( ) Rad Survey ( ) Other_

( ) Detector Tubes • •

Type: ( ) Other

Personnel Decontamination (Attach Diagram)

Required ( x ) * Not Required (

Equipment Decontamination (Attach Diagram)

Required ( x ) Not Required (

If required, describe and list equipment*

Disposable clothing will be placed in plastic bags and containerized on s i te .

5435A

Page 8 of 14B-14

C. Personnel Protective Equipment

1. Level of Protection

A ( ) B ( ) C ( )- • ' J*"~1 — — -T •.•»

Pond Sediment Sampling

D ( x) Location/Activity:

A() B ( ) C ( x ) D ( ) Location/Activity:

Pond Sediment Sampling (Contingency) _

2. Protective Equipment (specify probable quantity required)

Respiratory ( ) N/A

( ) SCBA, Airline

( x) Full Face Respirator(Cart. GMC-H )

( ) Escape Mask

( ) None

( } Other_

( ) Other

Head t Eye C ) N/A

( ) Hard Hat

( x) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( ) None

( ) Other

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

(x ) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify,

( ) Other

{ ) Other

Hand Protection ( ) N/A

(x ) Under gloves Cot tonType

( ) GlovesType

(x ) Overgloves RubberType

( ) None

( ) Other

Page 7 of 14B-15

Foot Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

3. Monitoring Equipment ( ) N/A

( ) CGI ( )

( ) ©2 Meter ( ) FID

( ) Rad Survey ( ) Other

( ) Detector Tubes • •

Type: ( ) Other

D. Personnel Decontamination (Attach Diagram)

Required ( x ) * Not Required ( )

Equipment Decontamination (Attach Diagram)

Required ( x ) Not Required ( )

If required, describe and list equipmentDisposable clothing will be placed in plastic bags and containerized on site.

Page 8 of 14B-16

•5435A

C. Personnel Protective Equipment

1. Level of Protection

A ( ) B ( ) C ( ) D ( x) Location/Activity:

Leachate Seep and Sediment Sampling

A ( ) B ( ) C ( x ) D ( ) Location/Activity:

Leachate Seep and Sediment Sampling (Contingency)

2. Protective Equipment (specify probable quantity required)

Respiratory ( ) N/A

( ) SCBA, Airline

( x) Full Face Respirator(Cart . GMC-H )

( ) Escape Mask

( ) None

( ) Other,

( ) Other

Head & Eye C ) N/A

( ) Hard Hat

( x) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( ) None

( ) Other

Clothing ( ) N/A

( ) Fully Encapsulating Suit

{ ) Chemically ResistantSplash Suit

( ) Apron, Specify

(x ) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify

( ) Other

( ) Other

Hand Protection ( ) N/A

(x ) Undergloves CottonType

( ) GlovesType

(x ) Overgloves Rubber

( ) None

Type

( ) Other

of 14

Foot Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

3. Monitoring Equipment ( ) N/A

( ) CGI

( ) 02 Meter

( ) Rad Survey

( ) Detector Tubes

Type:

( ) PID

( ) FID

( ) Other

( ) Other

D. Personnel Decontaminat ion (Attach D i a g r a m )

Required ( x ) * Not Required ( )

Equipment Decontaminat ion (Attach Diagram)

Required ( x ) Not Required ( )

If requi red , describe and list equipmentDisposable clothing will be placed in plastic bags and containerized on s i te .

5435A

Page 8 of 14B-18

C. Personnel Protective Equipment

1. Level of Protection

A ( ) B ( ) C ( ) D (

_ Groundwater and Pond Water Sampling——^—^-^^—^^——

Location/Activity:

A ( ) B ( ) C ( x ) D ( ) Location/Activity:

_ Groundwater and Pond Water Sampling (Contingency) _

2. Protective Equipment (specify probable quantity required)

Respiratory ( ) N/A

( } SCBA, Airline

( x ) Full Face Respirator(Cart. GMC-H )

( ) Escape Mask

( ) None

( ) Other_

( ) Other

Head & Eye C ) N/A

( ) Hard Hat

(x ) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( ) None

( ) Other

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

( x ) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify

{ ) Other

( ) Other

Hand Protection ( ) N/A

( x ) Undergloves CottonType

( ) Gloves

( x) Overgloves

( ) None

Type

Type

( ) Other

Page 7 of 14•D_I a

3.

Foot Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

Monitoring Equipment ( ) N/A

( ) CGI

( ) 02 Meter

( ) Rad Survey

( ) Detector Tubes

Type:

( )

( ) FID

( ) Other

( ) Other

D. Personnel Decontamination (Attach Diagram)

Required ( x ) * Not Required ( )

Equipment Decontamination (Attach Diagram)

Required ( x ) Not Required ( )

If required, describe and list equipment*Disposable clothing will be placed in plastic bags and containerized on site-

5435A

Page 8 of 14B-20

C. Personnel Protective Equipment

1. Level of Protection

A ( ) B ( ) C ( ) D ( * ) Location/Activity:

River water and Sediment Sampling

A ( ) B ( ) C ( ) D ( x ) Location/Activity:

River water and Sediment Sampling (Contingency)

2. Protective Equipment (specify probable quantity required)

Respiratory ( ) N/A

( ) SCBA, Airline

( ) Full Face Respirator(Cart. )

( ) Escape Mask

( x) None

( ) Other_

( ) Other

Head & Eye C ) N/A

( ) Hard Hat

( x) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( ) None

( ) Other

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

(x ) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify

( ) Other

( ) Other

Hand Protection ( ) N/A

( *) Undergloves CottonType

( ) GlovesType

(* ) Overgloves RubberType

( ) None

( } Other

Page 7 of 14B-21

root Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

3. Monitoring Equipment ( ) N/A

( ) CGI

( ) 02 Meter

( ) Rad Survey

( ) Detector Tubes

Type:

< ) PID

{ ) FID

( ) Other

( ) Other

D. Personnel Decontaminat ion (Attach Diagram)

Required ( x ) * Not Required { )

Equipment Decontamination (Attach Diagram)

Requi red ( x ) Not Required ( )

If r equ i red , describe and list equipment

Disposable c lothing will be placed in plastic bags and containerized on s i te .

5435A

Page 8 of 14B-22

C. Personnel Protective Equipment

1. Level of Protection

A ( ) B ( ) C ( )Fish and Invertebrate Sampling

D ( x) Location/Activity:

( ) B ( ) C ( x)

Fish and Invertebrate Sampling

D { ) Location/Activity:

(Contingency)

Protective Equipment (specify

Respiratory ( ) N/A

( ) SCBA, Airline

( x) Full Face Respirator(Cart. )

( ) Escape Mask

( ) None

( ) Other.

( ) Other

Head fc Eye C ) N/A

( ) Hard Hat

( x) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( ) None

( ) Other

probable quantity required)

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

(x ) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify

( ) Other

( ) Other

Hand Protection ( ) N/A

(x ) Undergloves CottonType

( ) GlovesType

(x } Overgloves Rubber

( ) None

Type

( ) Other

Page 7 of 14B-23

Foot Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

3. Moni tor ing Equipment ( ) N/A

( ) CGI

{ ') 02 Meter

( ) Rad Survey

( ) Detector Tubes

Type:

( ) PID

( ) FID

( ) Other

( ) Other

D. Personnel Decontaminat ion (Attach Diag ram)

Required ( x ) * Not Required ( )

Equ ipment Decontaminat ion (Attach Diagram)

Required ( x ) Not Requi red ( )

If requi red , describe and list equipmentDisposable clothing will be placed in plastic bags and containerized on s i te .

543SA

Page 8 of 14B-24

C. Personnel Protective Equipment

1. Level of Protection

A ( ) B ( ) C ( )

Private Well Sampling

D (x ) Location/Activity:

A ( ) B ( ) C ( ) D ( x ) Location/Activity:

Private Well Sampling (Contingency)

2. Protective Equipment (specify probable quantity required)

Respiratory ( )

( ) SCBA, Airline

N/A

( ) Full Face Respirator(Cart. )

( ) Escape Mask

( x) None

( ) Other_

( ) Other

Head & Eye C ) N/A

( ) Hard Hat

( ) Goggles

( ) Face Shield

( ) Chemical Eyeglasses

( x) None

( ) Other

Clothing ( ) N/A

( ) Fully Encapsulating Suit

( ) Chemically ResistantSplash Suit

( ) Apron, Specify

( ) Tyvek Coverall

( ) Saranex Coverall

( ) Coverall, Specify

( ) Other

( ) Other

Hand Protection ( ) N/A

{ ) UnderglovesType

( ) Gloves

( } Overgloves

(x ) None

Type

Type

( ) Other

Page 7 of 14B-25

3.

Foot Protection ( ) N/A

( x) Safety Boots

( x ) Disposable Overboots

( ) Other

Monitoring Equipment ( ) N/A

( ) CGI

( ) 02 Meter

( ) Pad Survey

( ) Detector Tubes

Type:

( ) PID

( ) FID

( ) Other

( ) Other

D. Personnel Decontamination (Attach Diagram)

Required ( x ) * Not Required ( )

Equipment Decontamination (Attach Diagram)

Required ( x ) Not Required ( )

If required, describe and list equipment*Disposable clothing will be placed in plastic bags and containerized on site,

5435A

Page 8 of 14B-26

E. Personnel

NAME

1. Elizabeth Uhl

2. Rae Mindock

3 . Dan Malinowski

4. Mike Loch

5 . James Jakubiak

6. Ed Need

7.

8.

9.

10.

WORK LOCATIONTITLE/TASK

Bannockburn/Geologist

Bannockburn/Engineer

Bannockburn/Engineer

Bannockburn/Engineer

Bannockburn/Geologist

Bannockburn/Geologist

MEDICAL FIT TESTCURRENT C U R R E N T

C E R T I F I C A T I OLEVEL

( « )

( x )

( x )

( x )

( * )( X )

( x )

( x )

( x )

(x )

( * )(x )

(B-T)

(B-T )

(B-T )

(B-S )

( * )

(B-T)

Site Safety Coordinator Elizabeth Uhl

*Weston Safety Training Nov. 6-8, 1985

5435A.

Page 9 of 14

B-27

F. Activities Covered Under this Plan

Task No.

16

17

18

19

20

Description

Waste Characterization and Quantification

Geophysical Survey

Hydrogeologic Study

Groundwater Sampling

River, Pond, Soil and Leachate Sampling

PreliminarySchedule

January 6-24, 1986

November 18-December 20, 1985

January 3-May 30, 1986

February 1-September 19, 1986

February 1-September 19, 1986

•O

!iQ0>

»-•O

O

G. Subcontractor's Health and Safety Program Evaluation ,

Name and Address of Subcontractor; H..ff f. H..ff. T^ ^llit.0 1a 1An M T ~rr..nQO

La Grange. II 60525. 312-579-5940.

Activities to be Conducted by Subcontractor; All Samplin

EVALUATION CRITERIA *

Item Adequate Inadequate Comments

Medical Surveillance Program ( x) ( ) _

Personal Protective Equipment Availability (x) ( ) _

i On-Site Monitoring Equipment Availability ( x) ( )>

Safe Working Procedures Specification ( X) ( )~j

> Training Protocols ( X) ( )•h

-• Ancillary Support Procedures (if needed) ( ) ( )Efc

Emergency Procedures ( ) ( )

Evacuation Procedures Contingency Plan ( ) ( )

Decontamination Procedures Equipment ( X ) ( )

Decontamination Procedures Personnel (X ) ( )

GENERAL HEALTH AND SAFETY PROGRAM EVALUATION: ADEQUATE ( ) INADEQUATE ( )

ADDITIONAL COMMENTS: *N/A Huff & Huff, Inc. will be covered by WESTON'S Health & Safety Plan.

EVALUATION CONDUCTED BY: Daniel R. Mallnowskl DATE: October 2T. 198S

Contingency Contacts

Agency

Fire Department

Police Department

Health Department

Poison Control Center

State EnvironmentalAgency

EPA-Regional Office

EPA-ERT. ICOM

Spill Contractor

State Police

F.A.A.

Civil Defense

On Site Coordinator

Site Telephone

Nearest Telephone

Contact

Art Johnson

Duane Worth

Carrol Klint

Specialist on duty

Jeff Larson

Dan Caplice

Specialist on duty

N/A

Capt. Ray Peat

Specialist on dutyJerry ZotawRockford. II

Elizabeth Uhl

M/A

Phone

JL1 5-544-2909 _

815-544-9626

815-544-2951

1-800-942-5969

217-782-6760

312-886-0397

201-321-6660

N/A

815-963-7686

815-968-6712

HomeWork-312-295-6020

. N/A

OtherWeston-24 Hour Emergency

Contingency Plans

Spill, Accidental Release; Describe

815-547-7935 (Boone County Conservation)(Location)

No. (215) 524-1925 (or 1926)

Fire Explosion; Describe_

Other; Describe

5435A

Exit Routes, Communication Systems; Describe Access road to Appleton

Road. Phone available at Boone County Conservation Off ice , adjacent to

site (547-79351Page 12 of 14

B-30

MEDICAL EMERGENCY

Name of Hospital St.-Joseph Hospital

Address;1005 Julian St.. Belvidere. II

Name of Contact Coleen Werner

Phone No. 544-3411

Address: 1005 Julian St. Phone No. 544-3411 Ext. 208

Route to Hospital: (Attach Map) South on Appleton

East on Newbere

NE on Locust

SE on Warren Ave

NE on Julian

Travel TimeFrom Site (Minutes) in minutes

Distance toHospital (Miles) 3_

Name/Number of 24 Hr. Ambulance Service Public Safety Bldg.

544-2144

Page 13 of 14B-31

HEALTH AND SAFETY PLANAPPROVAL/SIGN OFF FORMAT

I have read, understood, and agreed with the informationset forth in this Health and Safety Plan (and attachments)and discussed in the Personnel Health and Safety briefing.

Name Signature Date

Name Signature Date

Name Signature Date

Name Signature Date

Name Signature Date

Site SafetyCo-ordinator

Signature Date

Director, CorporateHealth and Safety

Signature Date

Project Manager Signature Date

Project Director/Department Manager

Signature Date

Personnel Health and Safety Briefing Conducted By:

Name Signature Date

5435A

Page 14 of 14

B-32

CHEMICAL DATA SHEET

Chemical Name: BenzeneSyn: Benzol

DOT Name: DOT Placard Number:

Chemical Formula: CgHg Boiling Pt: 80.093'-80-094'C

Physical State: Clear liquid Freezing Pt: -11.11*

Molecular Weight: 78.12 Flash Pt:

Vapor Pressure: 100 mm (? 26.1*C Flammable Limits:

Specific Gravity: 0.8794 0 20*C Melting Pt:

Solubility: Hater: Alcohol:

TLV: 10 ppmIDLH: 2000 ppm

Odor Threshold:

LD50: Oral (rat) s 3800 mg/kg; Inhal LCLQ (human) * 20,000 ppmover 5 minutes.

Reactivity: Can react vigorously with oxidizing materials, such asBr+5, Clp, Cr03, 02 NC104, 02, 03, perchlorates (A1C13 +FCToJ, (H2S04 + permanganates). K20 (AgC104 + acetic add)and Na202. Incompatible: Dlborane.

Neutralization:

Toxic Information/Health Hazards: Poisoning occurs most commonlythrough Inhalation of the vapor, though benzene can penetrate the skin,and poison 1n that way. Locally, benzene has a comparatively strong1rr effect, producing erythema and burning, and. In more severe cases,edema and even blistering. Following absorption of benzene,elimination Is chiefly through the lungs, when fresh air 1s breathed.The portion that 1s absorbed Is oxidized, and the oxidation productsare combined with sulfurlc and glycuronic adds and eliminated In theurine. This may be used as a diagnostic sign. Benzene has a definitecumulative action, and exposure to relatively high cone Is not seriousfrom the point of view of causing damage to the blood-forming system,provided the exposure is not repeated. On the other hand, dailyexposure to cone of 100 ppm or less will usually cause damage Ifcontinued over a protracted period of time. There Is great Individualvariation 1n the signs and symptoms of chronic benzene poisoning.Benzene 1s a common air contaminant. Dangerous fire hazard whenexposed to heat or flame. Moderate explosion hazard when Its vaporsare exposed to flame. Use adequate ventilation. Dangerous disasterhazard, highly flammable. Fight fire with foam, COz, dry chemical.

B-33

CHEMICAL DATA SHEET

Chemical Nam: Ethyl Benzene

DOT Name: DOT Placard Number:

Chemical Formula: C6H5C2H5B0111ng Pt: 136*C

Physical State: Liquid Freezing Pt: 95*C

Molecular Weight: 106

Vapor Pressure: 100 mm 9 26*C

Specific Gravity:

Flash Pt: 59'F

Flammable Limits: 1-6.7%

Melting Pt:

Solubility: Water:Oil:

Alcohol:Other:

5000 mg/kg, Inhalation

TLV: 100 ppm

Odor Threshold:

LD50:(rat) » 3500 mg/lcg, dermal (rabbit)TC^p (human) » 100 ppm for 4 hours.

Reactivity:

Neutralization:

Toxic Information/Health Hazards: Poses moderate threat to humansvia Irritation to skin, eyes, and mucous membranes via the oraland Inhalation routes. Concentration of 0.1X 1n air Is anIrritant to eyes; concentration of 0.2X 1s extremely Irritating atfirst, then causes dizziness, Irritation of the nose and throatand a sense of congestion of the chest. Erythema and Inflammationof the skin may result from contact of the skin.

NB:1

B-34

CHEMICAL DATA SHEET

Chemical Name: Methyl naphthaleneSyn: Methylnaftalen

DOT Name: DOT Placard Number:

Chemical Formula:

Physical State:

Molecular Weight: 142.21

Vapor Pressure:

Specific Gravity:

Solubility: Hater:Oil:

Boiling Pt:

Freezing Pt:

Flash Pt:

Flammable Limits:

Melting Pt:

Alcohol:Other:

TLV:

Odor Threshold:

LD50: Oral (rat) « 4360 mg/kg.

Reactivity:

Neutralization:

Toxic Information/Health Hazards: Low toxlclty via Ingestlon; moderatetoxlclty via skin Irritation. When heated to decomposition, 1t emitsacrid smoke and fumes.

NB:1

B-35

CHEMICAL DATA SHEET

Chemical Name: NapthaleneSyn: tar camphor, white tar, moth flakes, napthalin

DOT Name: DOT Placard Number:Shipping regulations (air) crude or refined: flammable solidlabel.

Chemical Formula: C1QH8 Boiling Pt: 217.96*C

Physical State: Colorless, brown Freezing Pt:or white crystalline; sublimes at room temp.Molecular Weight: 128.16 Flash Pt: 176*F

Vapor Pressure: 1 mm 9 52.6*C Flammable Limits: 0.91-5.9Z

Specific Gravity: 1.145 (20/4*C) Melting Pt: 80.2'C

Solubility: Water: Insoluble Alcohol: X011: Other: Benzene, ether

TLY: 10 ppmIDLH: 500 ppm

Odor Threshold: Strong coal tar odor (mothballs)

LD50: Oral LD,Q (child) « 100 mg/kg; oral LD50 (rat) -1780 mg/kg. 1p LDLO (mouse) • 150 mg/kg.

Reactivity: Strong oxidizers.

Neutralization: Fight fire with water, C02. dry chemical.

Toxic Information/Health Hazards: Experimentally causes theformation of neoplasms via subcutaneous route. Systemic reactionsInclude nausea, headache, diaphoresis, hematurla, fever, anemia,liver damage, convulsions and coma. Moderate fire hazard whenexposed to heat or flame. Other exposure symptoms Include eyeIrritation, confusion, excitement, malaise, vomiting, abdominalpain. Irritated bladder, profuse sweating, jaundice,hemoglobinuria, renal shutdown, dermatitis.

NB:1

B-36

X Cw<t«* t et •* Arch. tod. NM/T/I W426-441 (1954).4. Ma, KJ Scanrf. /L topi OH. S4fJ/:16H»4 (1«7)).

ffmuMv o< Hta/Wum Oood* torOc/nof*~ofy, DHIW Pub. No. (NIH) T»-1J47

fcthtdu. MO

TOLUENE

Toluol

QH,CH,

Skin

nv, KB ppm ( * 375 mf/m>)

5TEL150 ppm ( » 560 mt/m>)

Toluene is a colorless liquid with a typical aromatic hy-drocarbon odor. Its molecular weight and specific gravityare 92.13 and 0.866. respectively. The boiling point is110.7* C and solidifies at -95" C At 25* C. the vapor pres-sure is 28 mm Hg. The closed cup flash point is 40' F. It isinsoluble in water, but miscible with most organic solvents.

Formerly derived solely from coal tar, toluene is nowobtained chiefly from petroleum, and is present in gasolineand many petroleum solvents. It is used as a solvent inpaints and coatings, for rubber, oils, resins, etc.; as a rawmaterial for the manufacture of benzene and a host ofother chemicals, including TNT, TDI, and ingredients ofdetergents, dyes and drugs.

Because of its wide industrial use and chemical similari-ty to benzene, the literature of industrial toxicology andindustrial medicine, particularly the latter, record numer-ous investigations of the toxic effects of toluene. Accord-ing to Patty"> the concentrations of toluene and benzenerequired to cause prostration of mice are apparently 3000ppm and 4700 ppm, respectively. Death from acute poison-ing results from 10,000 ppm toluene compared with 14,000ppm of benzene. Several incidents of workers being over-come by toluene vapor, usually in confined spaces, havebeen reported. Longley and co-workers'*) describe such anevent aboard ship where 26 men were overcome. Therewere no deaths or serious aftereffects. No irritation of eyesor respiratory passages was observed.

From the standpoint of chronic poisoning, toluene doesnot cause the severe injury to the bone marrow character-istic of benzene poisoning. Gerarde") stated that the my-clotoxicity of benzene was completely absent in tolueneand other alkyl derivatives of benzene. Von Oettingen eta*4> found that exposure of rats at 2500 to 5000 ppm oftoluene caused a temporary decrease in the white-cellcount, but no evidence of injury to blood-forming organsor liver. Greenburg and co-workers'1) studied a group ofpainters exposed to toluene in concentrations rangingfrom 100 to 1100 ppm. Their findings included enlargementof the liver, macrocytosis, moderate decrease in erythocytecount and absolute rymphocytosis, but no leukopenia.

Wilson'*) found that among workers exposed at lessthan 200 ppm of toluene there were some complaints ofheadache, lassitude and nausea, but physical findings wereessentially negative. At concentrations between 200 and500 ppm impairment of coordination, momentary loss ofmemory and anorexia were also present. Between 500 and1500 ppm palpitation, extreme weakness, pronounced loss

of coordination and impairment of reaction time were not-

ed. The red cell count fell in many instances, and there

were two cases of aplastk anemia, in which recovery fol-

lowed intensive hospital treatment. A later comment by

Wilson,!*) however, suggests that he did not rule out the

possibility that some of the above effects were due to a

benzene impurity in the toluene used.

According to Fairhall.* severe exposure to toluene mayresult in a pronounced drop in the red count and partialdestruction of the blood-forming elements of the bonemarrow. However, Gerarde<*> stated that extensive animalstudies dearly indicate that toluene rs not a bone marrowpoison. While there have been occasional reports of aplas-tic anemia attributed to toluene,™ in some instances thepresence of benzene was not precluded, and there havebeen no "epidemics" of this disease among toluene work-ers comparable to those which have resulted from ben-zene, Powarsna reported six cases of aplastic anemia, oneof them fatal, among glue sniffers. Although toluene wasthe solvent chiefly used, no analysis was given of the glueinvolved in the fatal case. Exposures in these cases aremuch greater than would normally arise from occupationaluse of toluene. Thus Knox and Nelsonmi described an in-stance of permanent encephalopathy involving a man whoinhaled toluene regularly for over 14 years.

Von Oettingen and co-workers<4> found that humansubjects exposed at 200 ppm suffered slight but definitechanges in muscular coordination. They concluded thatsuch concentrations were unlikely to have any discernibleuntoward effects on health. Gerarde<*> however, believedthat von Oettingen's work did not justify the 200 ppm lim-it. Ogata ef a*12* found that experimental human subjectsexposed at 200 ppm for seven hours showed prolongationof reaction time, decrease in pulse rate and in systolicblood pressure. They consider 200 ppm too high as theMAC. Takeuchif") exposed rats at 200 ppm and higher con-centrations of toluene for 32 weeks and then to benzenefor 39 days. On the basis of differences found between thetoluene-exposed animals and controls, e.g.. changes inweight of adrenal glands, he suggested that the MAC of200 ppm for toluene should be reconsidered.

Smyth er al reported an oral LD», administered to rats.to be 7.53 ml/kg.<">

On the basis of the above data, a reduction in the TLVfor toluene from 200 ppm to 100 ppm is recommended,with a STEL of 150 ppm.

Other recommendations: Cook (1945) 200 ppm; Smyth(1956) comments that this limit may permit early signs ofnarcosis; Elkins (1959) 200 ppm; ANSI (1967) 200 ppm; USSR(1967) 14 ppm; Czechoslovakia (1969) 50 ppm; West Ger-many (1974) 200 ppm; Sweden (1975) 100 ppm; East Ger-many (1973) 50 ppm; NIOSH (1973) 100 ppm.

References:

1. Pttty. FA: Induttritl Hygiene A Toxicology. 2nd «d.. Vol. II. P1226, Imencience, NY (1963).

1 Un0«y, LQ, lent, A.T, IMAMV. O: Arc*. Env. Hetlth 74:481(W67).

iJ

B-37

CHEMICAL DATA SHEET

Chemical Name: Xylene

DOT Name: DOT Placard Number:

Chemical Formula: CgH4 (CH3)2 Boiling Pt: 281-292'F

Physical State: Colorless liquid Freezing Pt:

Molecular Weight: 106 Flash Pt: 81-90'F

Vapor Pressure: 7-9 Flammable Limits: 1-7J

Specific Gravity: Melting Pt: -12 to -55*F

Solubility: Hater: Very slight Alcohol:Oil: Other:

TLV: 100 pppm IDLH: 10.000 ppm

Odor Threshold: Aromatic odor

LD50:

Reactivity: Strong oxldlzers

Neutralization:

Toxic Information/Health Hazards: Dizziness; excitement; drowsiness;Incoherence; staggering; Irritated eyes, nose, throat; cornealvaluoHzatlon; anorexia; nausea; vomiting; abdominal pain; dermatitis.Affects CMS, eyes, GI tract, blood, liver, kidneys, skin.

NB:1

B-38

JOLYCHLORINATED BIPHENYLS

£tAS RN: 1336363 NIOSH #: TQ 1350000

'lp: 340°-375°. flash p: 383°F (COC), d: 1.44 @ 30°.For toxicity information, see individual mixtures below.

" A icries of technical mixtures consisting of many isomersMd compounds that vary from mobile oily liquids to•lute crystalline solids and hard noncrystalline resins.Technical products vary in composition, in the degree

-«f chlorination and possibly according to batch (I ARC"j 7,262,74).

JlYNS:V AIOCLOR CHLOREXTOL(-OLOPHEN CHLOKO BIPHENYL

.-QOXNUNATED BIPHENYL CHLORO-l.l-SIPHENYI.

rOOOUNATED OIPHENYL CLOPHEN

'OLOUNATED .DIPHENYLENE KANECHLOR s

NOFLAMOL PYRALENE

PCBS PY HANOI

PHENOCHLOR SANTOTHERM

POLYCHLORINATED 1IPHENYL THERMINOL FR-I

POLYCHLOROBIPHENYL

TOXICITY DATA:Carcinogenic Determination: Human Suspected IARC**

18,43,78. Toxicology Review: EVHPAZ 1,105,72;JOCMA7 18,109,76; FEPRA7 34,1675,75; ARVPAX14,139,74; ARPAAQ 94,125,72; CHRYAQ 49(4),14,76; STEVA8 2(4),305,74; BISNAS 20,958,70;27ZTAP 3,34,69. Occupational Exposure to Polychlo-rinated Biphenyls recm std: Air: TWA 1.0 ug/m3NTIS*». "NIOSH- Manual of Analytical Methods"VOL 1 244,253. VOL 2 S121, VOL 4 SI20*. NIOSHCurrent Intelligence Bulletin 7, 1975. Reported in EPATSCA Inventory, 1980. EPA TSCA 8E No: 07780209-Followup Reply Received as of April, 1979.

THR: A susp hmn CARC. HIGH-MOD acute orl, ihl,skn. Also causes a chloracne. Like the chlorinatednaphthalenes, the chlorinated diphenyls have two dis-tinct actions on the body, namely, a skn effect and atoxic action on the liver. The lesion produced in theliver is an acute yellow atrophy. This hepato toxic ac-tion of the chlorinated diphenyls appears to be in-creased if there is exposure to carbon tetrachloride atthe same time. The higher the chlorine content of thediphenyl compound, the more toxic is it liable to be.Oxides of chlorinated diphenyls are more tox than theunoxidized materials. The skin lesion is known aschloracne, and consists of small pimples and dark pig-mentation of the exposed areas, initially. Later, come-dones and pustules develop. In persons who have suf-fered systematic intoxication, the usual signs andsymptoms are nausea, vomiting, loss of weight, jaun-dice, edema and abdominal pain. Where the liver dam-age has been severe the patient may pass into comaand die.

Fire Haiard: Slight, when exposed to heat or flame.Disaster Hazard: Dangerous; when heated to decomp,

they emit highly tox fumes.For further information see PCB's, Vol. 3, No. 4 of DPIM

Report.B-39

APPENDIX C

HEAT STRESS AND COLD EXPOSURE

MONITORING

Heat Stress Monitoring .

For monitoring the body's recuperative ability to excess heat one ormore'of the following techniques should be used as a screeningmechanism. Monitoring; of personnel wearing Impervious clothing shouldcomence when the ambient temperature Is 70°F or above. Frequency ofmonitoring should Increase as the ambient temperature Increases or atslow recovery rates are Indicated. When temperatures exceed 85'Fworkers should be monitored for heat stress after every work period.

1. Heart rate (HR) should be measured by the radial pulse for 30seconds as' early is possible In the resting period. The HR at thebeginning of the rest period should not exceed 110 beats perminute. If the HR Is higher, the next work period should beshortened by 10 minutes (or 331), while the length of the restperiod stays the same. If the pulse rate Is 100 beats per minuteat the beginning of the next rest period, the following work cycleshould be shortened by 331.

2. Body temperature should be measured orally with a clinicalthermometer as early as possible In the resting period. Oraltemperature (OT) at the beginning of the rest period should notexceed 99*F. If It does, the next work period should be shortenedby 10 minutes (or 331), while the length of the rest period staysthe same. However, If the OT exceeds 99.7*F at the'beginning ofthe next period, the following work cycle should be furthershortened by 331. OT should be measured again at the end of therest period to make sure that 1t has dropped below 99*F.

3. Body water loss (BWL) due to sweating should be measured byweighing the worker In the morning and In the evening. Theclothing worn should be similar at both weighings; preferably theworker should be nude. The scale should be accurate to plus orminus 1/4 Ib. BWL should not exceed 1.51 of the total body weight.If 1t does, the worker should be Instructed to Increase his dallyIntake of fluids by the weight lost. Ideally, body fluids shouldbe maintained at a constant level during the work day. Thisrequires replacement of salt lost 1n sweat as well.

4. 6ood hygienic standards must be maintained by frequent change ofclothing and dally showering. Clothing should be permitted to dryduring rest periods. Persons who notice skin problems shouldImmediately consult medical personnel.

Effects of Heat Stress

If the body's physiological processes fall to maintain a normal bodytemperature because of excessive heat, a number of physical reactionscan occur ranging from mild (such as fatigue, Irritability, anxiety,and decreased concentration, dexterity, or movement) to fatal.Standard reference books should be consulted for specific treatment.

c-i

Heat-related proble** art:

- Htit Rash; caused by continuous txposurt to heat and hu>1d air and'aggravated by chafing clothes. Decreases ability to tolerate heatas well as being a nuisance.

- Heat cramps; caused by profuse perspiration with Inadequate fluidintake and cnendcal replaceoent (especially salts). Signs: Msclespasn and pain 1n the extremities and abdooen.

• Heat exhaustion; caused by Increased stress on various organs to•eet increased demands to cool the body. Signs: shallow breathing;pale, cool, moist skin; profuse sweating; dizziness and lassitude.

• Heat stroke; the most severe font of heat stress. Body mist becooled loneifiately to prevent severe Injury and/or death. Signs andsymptoms are: red, hot, dry skin; no perspiration; nausea; dizzinessand confusion; strong, rapid pulse; cow.

Effects of Cold Exposure

Persons working outdoors In temperatures at or below freezing may befrostbitten. Extreae cold for a short time may cause severe Injuryto the surface of the body, or result In profound generalizedcooling, causing death. Areas of the body which have high surface-area- to-volume ratio such as fingers, toes, and ears, are the mostsusceptible.

Two factors Influence the development of a cold Injury: ambienttenperature and the velocity of the wind. Wind chill Is used todescribe the chilling effect of moving air In combination with lowtemperature. For Instance, 10'F with a wind of 15 artles per hour .(mph) Is equivalent In chilling effect to still air at -18*F.

As a general rule, the greatest Incremental Increase In wind chilloccurs when a wind of 5 mph Increases to 10 «ph. Additionally,water conducts heat 240 tines faster than air. Thus, the body coolssuddenly when chemical-protective equipment 1s revved If theclothing underneath Is perspiration soaked.

Local Injury resulting fro* cold 1s Included 1n the generic ternfrostbite. There are several degrees of damage. Frostbite of theextremities can be categorized Into:

- Frost nip or Incipient frostbite; characterized by suddenlyblanching or wnitening or skin.

- Superficial frostbite: skin has a waxy or white appearance and1$ firm to the toucn, Dut tissue beneath 1$ resilient.

C-2

- Deep frostbite: tissues ere cold, pit, and solid; extremelyserious injury.

Systemic hypothermia Is caused by exposure to freezing or rapidlydropping temperature. Its symptoms are usually exhibited In fivestages: 1) shivering, I) apathy, Hstlessness. sleepiness, and(sometimes) rapid cooling of the body to less than 95*F, 3)unconsciousness, glassy stare, slow pulse, and slow respiratoryrate, 4) freezing of the extremities, and finally, 5) death.

Standard reference books should be consulted for specifictreatments.

C-3

APPENDIX D

FORMS FOR SITE DOCUMENTATION

SITE CLEARANCE WORKSHEET FORMHEALTH AND SAFETY MONITORING PROGRAM

EMPLOYEE NAME:

SOCIAL SECURITY 1:

FIRM: !

LOCATION: i1 i

MEDICAL CERTIFICATION AVAILABLE: YES ( ) NO ( )(Pre-ass1gnment Medical Eval. Form)

DATE/LOCATION OF MOST RECENT PHYSICAL:Date Location

RESPIRATOR FIT JEST WORKSHEET AVAILABLE: YES ( ) NO ( )

DATE OF MOST RECENT VALID FIT TEST:Date

RESPIRATOR TYPE/DESIGNATION:M a k e / M o d e l 7 Size

TRAINING CERTIFICATES AVAILABLE: YES { ) NO ( )

LIST COURSES: , ,( ) Additional Information on Attached Sheet

SITE CLEARANCE (1-5) ( )

INTRUSIVE ACTIVITIES (A.B.C.D.N)NONINTRUSIVE ACTIVITIES (A.B.C.D.N)

ENCLOSED SPACE ENTRY (A.B.N) ( )

Environmental Source

Corporate Health i Safety Manager Firm

D-l

EQUIVALENT WORK EXPERIENCE:

( ) Additional Information onAttached Sheet

SITE ACTIVITY LOGHEALTH AND SAFETY MONITORING PROGRAM

EMPLOYEE NAME: SOCIAL SECURITY f

FIRM, CITY/LOCATION:

DATE OF LAST PHYSICAL/APPROVED MED. FACILITY NAME:

SITE NAME: SITE CATEGORY:

TASK/PHASE: SITE STATUS: Continuous ( ) Intermittent ( )

SITE EVALUATION FORM REFERENCE NO:

WORK ASSIGNMENT:

DATE(S) ON-SITE: FROM TO TOTAL CUMULATIVE HOURS ON-SITE:

TOTAL CUMULATIVE HOURS IN: PROTECTION LEVEL: A , B .C . D

PREVIOUS CUMULATIVE TIME ON ALL SITES (CATEGORY 1 I 2 ONLY) SINCE DATE OFLAST PHYSICAL:

TOTAL CUMULATIVE TIME ON ALL SITES (CATEGORY 112 ONLY) SINCE DATE OF LASTPHYSICAL:

ADDITIONAL INFORMATION FOR THIS WORK ASSIGNMENT - Please answer questions byplacing an "X" 1n Yes or No block. If Yes, please amplify on the reverseside.

Yes No

(a). Any notable occurances with respect to health and ( ) ( }safety?

(b). Any violations of health and safety rules observed? ( ) ( )

(c). Any accidental exposure to hazardous materials or . ( ) ( )conditions?

(d). Was an Incident report filed? ( ) ( )

(e). Any acute exposure to hazardous Materials? ( ) ( )

(f). Any physical difficulties experienced while on assign- ( ) ( )•ent?

(g). Additional Connents ( ) ( )

SIGNATURE OF EMPLOYEE: /DATE;

ON-SITE COORDINATOR: /DATE:

REGIONAL HEALTH t SAFETY SUPER. /DATE:

D-2

EXPOSURE INPUT FORM

HEALTH AND SAFETY MONITORING PROGRAM

EMPLOYEE INPUT

EMPLOYEE: SOCIAL SECURITY NO.:

SITE NAMEEXPOSURE LEVELS (HOURS)

BDATESON SITE

TOTAL •

REPORTING PERIOD:

REGIONAL HEALTH AND SAFETY SUPERVISOR (RHSS) INPUT

COMMENTS:

Followup Action Required;

Signature Date

HSM Followup TJate

HEALTH INPUT BY:Date

D-3

MONTHLY EXPOSURE/INJURY REPORT '

HEALTH AND SAFETY MONITORING PROGRAM

STE

i.-.oio/ee i

DATE

DATES ONSITE

EMPLOYEE NO.:.

INJURIES*

C«tl

Action P«qu1re4:

tilt

MSM fOllo»u9

'Injury or significant exposure requires Incident report filing.

D-4

EMPLOYEE INJURY/EXPOSURE INCIDENT REPORT

HEALTH AND SAFETY MONITORING PROGRAM

EMPLOYEE:

SHE NAME:

SITE CATEGORY:SITE EVALUATION FOR *EF. SO.:.

INCIDENT TYPE:

DATE Of INCIDENT:

LOCATION:

DATE:

C*»LOYEE NO.:_

TASK/PHASE:

SITE STATUS:

Eipoturi; _ Eiposure; _ Injury

TIKE:

SITE CONDITIONS AT TIME OF INCI5ENT:

Humidity

Jrecipitition

Cloud Cover

Other

TYPE OF EXPOSURE/INJURY:

MATERIAL EXPOSED TO (chr»ical compound name, physical statt. etc.):

MATURE OF EXPOSURE/INJURY (partt of body •iBOlW/lnjurnl. etc.):

KDICAL CARE RECEIVE {.ten, -nere. 6/ •Aon):

D-5

t 4

HAS HSO BEEN NOTIFIED: No V« (Atmh Documentitlen)

ME::AL CONSULTANTS

Pflyt1C«n Mil

MSM CDW.ENTS:

ACTIONS REQUIRED:

C*te

ACTIONS ccmrED:

D-6

KSO D«U

.,-Si;

MAS EXPOSURE/INJURY RESULTED IN:

Ot«th

Penwnent

Lots of Work Time

Otner

OTHER INDIVIDUAL INVClVED/AFFECTED:

WITNESSES:

POSSIBLE CAUSE OF INJURY/EXPOSURE:

WIRI OPERATIONS CONDUCTED USING APPROVED KEALTH I SAFETY PLAN:

____ Y«i Reference:

No E»pli in:

MS INJURY/EXPOSURE 5UE TO LIMITATIONS OF PROTECTIVE CLOTHING;

No

HAS £PA BEEN NOTIFIED: _ No _ Ye* (Atlich Docg»«nution)

MAS STATE REGULATORY AGENCY BEEN NOTIFIED:

_ No _ *e» (*tt*ch OocuwenUtlon)

D-7