WS-6081_22332_CA_LTRRPT_20210923

1044 Washington Street
Raleigh, NC 27605
[phone]
www.CatlinUSA.com
Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA

ENVIRONMENTAL | CIVIL | GEOTECHNICAL

Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA | Charleston, SC

September 23, 2021 North Carolina Department of Environmental Quality
Division of Waste Management UST Section Attn: Mr. Mark Petermann 1646 Mail Service Center Raleigh, NC 27699-1646 Re: Receptor Survey Letter Report
Former Texaco Food Mart #2 1700 Cotton Grove Road Lexington, North Carolina 27292 Incident Number: 22332 Risk Classification: H157D CATLIN Project No. 221185
Dear Mr. Petermann:
CATLIN Engineers and Scientists (CATLIN) is pleased to provide you with this letter report documenting site reconnaissance and receptor survey activities performed in general accordance with CATLIN proposal number 221185.P, dated June 25, 2021. Services were authorized by the North Carolina Department of Environmental Quality (NCDEQ) Task Authorization (TA) #01, approved June 28, 2021, and Contract Number N122019D. The approved scope of services for this Task Authorization was for the following services, which included:
• Obtain Right-of-Access (ROA) agreements for the 1610 Cotton Grove Road (MW-5) and the 1704 Cotton Grove Road (MW-6) parcels;
• Collect groundwater samples from nine monitoring wells (MW-1 through MW-6 and T-1 through T-3) for analysis per Standard Method (SM) 6200B (including EDB, MTBE & IPE);
• Conduct a receptor survey within 1,500 feet of the site;
• Prepare and submit an Annual Monitoring Report summarizing the findings.
CATLIN was unable to obtain access for monitoring well MW-5/MW-6 and was provided with a copy of the access agreement for the subject site.
Upon arrival to the site on August 10, 2021, CATLIN personnel completed the receptor survey and then attempted to locate the requested wells. Due to site redevelopment, the monitoring wells on the subject site appeared to all be destroyed. Monitoring well MW-6 could not be located and was presumed destroyed. Monitoring well MW-5 was located; however, the well and well shield were filled with concrete. Mr. Mark Petermann, with the NCDEQ Underground Storage Tank (UST) State Lead Program, was advised of the situation and agreed for CATLIN to just submit a letter report documenting the findings of the receptor survey.
September 24, 2021
Page 2 of 3

____________________________________________________________________________________
NCDEQ; 22332_Former Texaco Food Mart #2.docx CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021
The Former Texaco Food Mart #2 site is located at 1700 Cotton Grove Road, Lexington, North
Carolina (See Figures in Attachment A). Prior to completing any field activities, a site-specific
Health and Safety Plan (HASP) was prepared and is included in Attachment B. Potential hazards
were evaluated before beginning field work and are documented on an electronic Job Hazard
Analysis (JHA) form, also provided in Attachment B. Site photographs are provided in Attachment
C.

Receptor Information

CATLIN conducted the receptor survey on August 10, 2021. As part of the receptor survey,
CATLIN walked a 1,500-foot radius around the site and conducted a door-to-door survey of
properties within a 500-foot radius to identify potential receptors. Potential receptors located within
1,500 feet of the subject site are illustrated on Figure 2 (Attachment A) and summarized in Table
1 (Attachment D). Pertinent receptor information is described below.

Water Supply Wells

During the receptor survey, a total of 12 water supply wells were identified within 1,500 feet of the
site. Of the 12 wells, four were potable (three of which were within 1,000 feet of the site) and the
other ten wells were non-potable (all further than 250 feet from the site). As mentioned above, no
wells were present to be gauged during the site visit; however, as indicated in historical reports,
the surficial groundwater flow direction varied between the west-northwest and southwest
directions. Based on the historical groundwater flow direction, only potable well WSW-4 (located
980 feet west-southwest) is in the downgradient direction from the site. The remaining wells are
either in an upgradient or side-gradient direction.

Information regarding water supply wells within 1,500 feet of the site are detailed on Table 1
(Attachment D) and illustrated on Figure 2 (Attachment A).

Public Water Supply Wells

No public water supply wells were identified within 1,500 feet of the subject site. Based on
correspondence with the City of Lexington Water Resources department, municipal water should
be available to all parcels within the 1,500-foot radius, provided by either the City of Lexington or
Davidson Water, although some parcels would require a public line extension. The City of
Lexington draws its municipal water from Lake Tom-A-Lex and City Lake. Davidson Water draws
its water from the Yadkin River.

Surface Water

No surface water bodies were identified within 1,500 feet of the subject site.

Wellhead Protection Areas

On September 20, 2021, CATLIN accessed the NCDEQ, Division of Water Resources (DWR),
Wellhead Protection Program SWAPInfo 2.0 map and verified that there are no known wellhead
protection areas within 1,500 feet of the subject site.

September 24, 2021
Page 3 of 3

____________________________________________________________________________________
NCDEQ; 22332_Former Texaco Food Mart #2 CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021
Subsurface Structures

Subsurface utilities including water and sanitary sewer exist along NC Highway 8 (Cotton Grove
Road) and other roads in the immediate vicinity of the site.

Conclusions and Recommendations

Three potable wells were identified within 1,000 feet of the site. Based on distance and direction,
it does not appear that any of the wells are at risk to be impacted by the on-site dissolved
petroleum groundwater contamination. Municipal water appears to be available to all parcels
within the 1,500-foot radius.

The monitoring wells were destroyed during site redevelopment and samples could not be
collected. See Figure 3 (Attachment A) for the former well locations. During the last sampling
event conducted in June 2018, analytical laboratory results revealed that the samples from MW-
1 through MW-4 and T-1 contained multiple contaminants at concentrations that exceeded their
respective Title 15A of the North Carolina Administrative Code, Subchapter 2L, Section .0202
Groundwater Quality Standards (2L GWQS). Also, three constituents detected in MW-2 exceeded
their respective Gross Contaminant Levels (GCL). CATLIN recommends installing several
replacement wells on-site to monitor the dissolved groundwater contamination.

If we can be of any further assistance or if you have any questions, please contact us at (919)
838-2875.

Sincerely,

Sean O’Neil, PE
Project Manager

Attachments:
A Figures
B Daily JHA and HASP
C Site Photographs
D Table

____________________________________________________________________________________NCDEQ; 22332_Former Texaco Food Mart #2 CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021
ATTACHMENT A FIGURES
SITE LOCATION
COTTON GROVE RDINTERSTATE 85
Copyright:© 2013 National Geographic Society, i-cubed
FIGUREPROJECTTITLE
1FORMER TEXACOFOODMART #21700 COTTON GROVE RDLEXINGTON, NC
SITE VICINITY MAP
2,000 0 2,000 4,0001,000
Feet
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY22332221185SEPT 2021 AS SHOWN KMU/SJO
³
!(W!(W
!(W
!(W
!(W
!(P
!(P
!(P
!(W
!(W !(W
!(P
SITE LOCATION
1 ,0 0 0 F EET RADIUS
COTTON GROVE RDIN T E R S T A T E 8 5
WSW-4
WSW-3
WSW-1
WSW-2
WSW-8WSW-5
WSW-6
WSW-7
WSW-9250FEETRADI
U
S1 ,5 0 0 F EET RADIUS
WSW-11 WSW-12
WSW-10
Source: Esri, Maxar, GeoEye, Earthstar Geographics, CNES/Airbus DS,USDA, USGS, AeroGRID, IGN, and the GIS User Community
FIGUREPROJECTTITLE
2FORMER TEXACOFOODMART #21700 COTTON GROVE RDLEXINGTON, NC
POTENTIAL RECEPTOR MAP
500 0 500 1,000250
Feet
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY22332221185SEPT 2021 AS SHOWN KMU/SJO
NOTE: Well locations were obtained from previous reports prepared by other consultants and are approximate.
LEGEND
!(P Active PotableWater Supply Well
!(W Inactive Non-PotableWater Supply Well
³
!>
!>!>!>!>!(>
!(>
!(>!>!(>
!H
")<!H
")<!H
")<")<!H")<!H")<")<!HCOTTON GROVE RDMW-5
MW-4
MW-6
MW-3
AS-6 VE-7 T-4
VE-6
AS-5
AS-2
MW-1
VE-2
VE-4AS-4
VE-1T-3VE-5MW-2
T-1AS-1
VE-3
AS-3
T-2
FORMERSUPREME USTS
FORMERREGULARUSTS
FORMERDIESELUST
FORMERDIESELDISPENSER
FORMERGASOLINEDISPENSER
FORMERGASOLINEDISPENSER
FORMERKEROSENEDISPENSER
FORMERKEROSENEUST
Source: Esri, Maxar, GeoEye, Earthstar Geographics, CNES/Airbus DS,USDA, USGS, AeroGRID, IGN, and the GIS User Community
FIGUREPROJECTTITLE
3FORMER TEXACOFOODMART #21700 COTTON GROVE RDLEXINGTON, NC
SITE MAP
40 0 40 8020
Feet
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY22332221185SEPT 2021 AS SHOWN KMU/SJO
NOTE: Well locations were obtained from previous reports
prepared by other consultants and are approximate.
³
Abandoned Monitoring
Well (Type II)!>
LEGEND
Approximate Location
of Former UST Systems
Parcel Boundary
Destroyed Temporary Monitoring Well (Type II)")!>
Destroyed Monitoring Well (Deep)!(>
Destroyed Air Sparge!H
Destroyed Vapor Extraction")<Destroyed Monitoring Well (Type II)!>

____________________________________________________________________________________NCDEQ; 22332_Former Texaco Food Mart #2 CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021
ATTACHMENT B DAILY JHA AND HASP
Source Exposure Limit
Groundwater and/or soil vapor 0.5 ppm TLV-TWA ACGIH
Groundwater and/or soil vapor 100 ppm TLV-TWA ACGIH
Groundwater and/or soil vapor 20 ppm TLV-TWA ACGIH
Groundwater and/or soil vapor 100 ppm TLV-TWA ACGIH
Groundwater and/or soil vapor 50 ppm TLV-TWA ACGIH
Groundwater and/or soil vapor 10 ppm TLV-TWA ACGIH
Source Exposure Limit
atmosphere N/A
atmosphere N/A
surroundings N/A
Exposure Potential
Likely
Likely
Likely
Start Stop
10:30 12:00
12:00 12:15
12:15 14:00
14:00 15:00
15:00 16:45
Date and Time:
8/10/21 @ 9:30
Equipment Used:PPE D
Van #39 Mileage:
Weather:
MOB and Travel to site
On site safety briefing. Watch for snakes. Wear safety vest when near the road and watch for dogs during
receptor survey. Watch for cars when near and crossing road. Drink plenty of water.
Receptor survey conducted within 1,500 feet.
Biological Hazards
Name of Biological Hazard Source
Insect bites and stings
Cold Weather Operations Unlikely
Heat (ambient)
DAILY TASK
Snakes surroundings
Poison Plants (Ivy, Oak, and/or Sumac)surroundings
PERSONNEL ONSITE
Name and Company (Print)Signature
Nathaniel Newman / CATLIN
Chemical Hazards
Sunny 90s
Site-Specific Job Hazard Analysis
Location Where Task/Operation Performed
Durham, NC
Task/Operation
Gauge and Sample Wells, Receptor Survey
Employee Certifying this JHA
Print Name: Sean O'Neil, P.E.Signature:
Operational Phase
Monitoring
Date(s) this JHA
Conducted:
8/10/21
Potential Chemicals Concentration
BENZENE ppm
ETHYL BENZENE ppm
TOLUENE ppm
XYLENE, ALL ISOMERS ppm
METHYL TERT-BUTYL ETHER ppm
NAPHTHALENE ppm
Physical Hazards
Name of Physical Hazard Exposure Level/ Potential
* Gas and/or Diesel
Travel back to Raleigh office and Demob.
Likely
Slips/Trips/Falls Likely
surroundings
Looked for wells and took photos of site. All wells damaged or destroyed; unable to sample.
Start:End:
HEALTH AND SAFETY PLAN
PROJECT NAME: FORMER TEXACO FOOD MART #2
INCIDENT #: 22332
UST #: WS-6081
1700 COTTON GROVE ROAD,
LEXINGTON, NC
CATLIN PROJECT NUMBER: 221185
PREPARED FOR:
NORTH CAROLINA DEPARTMENT
OF ENVIRONMENTAL QUALITY
PREPARED BY:
CATLIN ENGINEERS AND SCIENTISTS
P.O. BOX 10279
WILMINGTON, NC 28404-0279
[phone]
PROJECT NAME and No.:
CLIENT NAME:
PROJECT ADDRESS:
SOIL:
GROUNDWATER:
FREE-PHASE PRODUCT:
PROJECT WORK
SCOPE:
NOTE: ATTACH SITE MAP(S), HOSPITAL ROUTE MAP(S) WITH WRITTEN DIRECTIONS, AND
MATERIAL SAFETY DATA SHEETS (MSDS) FOR EVERY CONTAMINANT LISTED ABOVE.
(Access information,
pass/badges required, etc.)
None
Monitoring Well Sampling, Top of Casing Surveying, and Receptor
Survey
Confirm access agreement/right to enter before Site Recon. If not
on file, must receive Verbal approval. If no approval, CAN NOT
PROCEED WITH WORK OR BILL TRAVEL TIME.
ADDITIONAL
INFORMATION:
(Describe free-phase product
contamination.)
(List all field activities to be
completed.)
Sean O'Neil - [phone]
Ben Ashba - [phone]
PROJECT MANAGER
NAME and NUMBER:
CONTAMINATION INFORMATION
FIELD ACTIVITIES
EMERGENCY CONTACT
(NAME and NUMBER):
911 - Emergency Contact
Sean O'Neil - [phone]
Ben Ashba - [phone]
Shane Chasteen - [phone]
HEALTH AND SAFETY PLAN
SITE SPECIFIC INFORMATION
Petroleum - Gasoline
Petroleum - Gasoline and/or Kerosine and/or Diesel
(Describe soil contamination
and list potential
contaminants.)
(Describe groundwater
contamination and list
potential contaminants.)
SITE CONTACT (NAME
and NUMBER):
Sean O'Neil - [phone]
Ben Ashba - [phone]
Former Texaco Food Mart #2 - CATLIN Project No. 221185
North Carolina Department of Environmental Quality
4100 Randleman Road, Greensboro, NC
NCDEQ SLP; SiteSpecificHASPinfo CATLIN Engineers and Scientists
CHAPTER 1 ORGANIZATIONAL STRUCTURE
CHAPTER 2 JOB HAZARD ANALYSIS
CHAPTER 3 SITE CONTROL
CHAPTER 4 TRAINING PROGRAM
CHAPTER 5 MEDICAL SURVEILLANCE REQUIREMENTS
CHAPTER 6 PERSONAL PROTECTIVE EQUIPMENT
CHAPTER 7 EXPOSURE MONITORING
CHAPTER 8 THERMAL STRESS
CHAPTER 9 SPILL CONTAINMENT PROGRAM
CHAPTER 10 DECONTAMINATION PROGRAM
CHAPTER 11 EMERGENCY RESPONSE/CONTINGENCY PLAN
CHAPTER 12 STANDARD OPERATING PROCEDURES
CHAPTER 13 CONFINED SPACES PROGRAM
CHAPTER 14 HOTWORK
CHAPTER 15 HAZARDOUS ENERGY CONTROL PROGRAM (LOTO)
TABLE OF CONTENTS
Date of Program:Site Name:Former Texaco Food Mart #2

SAFETY MEETING ATTENDANCE
PRINTED NAME and SIGNATURE COMPANY DATE

1.0 ORGANIZATIONAL STRUCTURE
(in compliance with 29 CFR 1910.120(b)(2))
1.1 Roles and Responsibilities
This chapter of the Health and Safety Plan describes lines of authority, responsibility, and communication as they
pertain to health and safety functions at this site. The purpose of this chapter is to identify the personnel who impact
the development and implementation of the site health and safety plan and to describe their roles and
responsibilities. This chapter also identifies other contractors and subcontractors involved in work operations and
establishes the lines of communication among them for safety and health matters.
* the general supervisor who has the responsibility and authority to direct all field activities under CATLIN's contract.
* the lines of authority, responsibility, and communication for safety and health functions
The organizational structure of this site’s safety and health program is consistent with OSHA requirements in 29
CFR 1910.120(b)(2) and provides the following site-specific information:
* other personnel needed for hazardous waste operations and emergency response and their general functions
and responsibilities
* the site safety and health officer who has the responsibility and authority to develop and implement this HASP
and verify compliance
This section is reviewed and updated as necessary to reflect the current organizational structure at this site.
All personnel and visitors on this site must comply with the requirements of this HASP. All persons must speak and
understand English as part of compliance with this HASP. Failure to comply with this HASP may result in disciplinary
action as determined by the Owner. The specific responsibilities and authority of management, safety and health, and
other personnel on this site are detailed in the following paragraphs. A site organizational chart illustrating the
hierarchy of personnel and lines of communication within this company and with additional contractors on site is found
in Figure 1-1. Let it be known that one individual can perform multiply roles, if deemed necessary.
The Project Manager (PM) for this site is Sean O'Neil. The PM has responsibility and authority to direct all work
operations. The PM coordinates safety and health functions with the Site Safety and Health Officer (SSHO), has the
authority to oversee and monitor the performance of the SSHO, and bears ultimate responsibility for the proper
implementation of this HASP. The specific duties of the PM are:
Preparing and coordinating the site work plan; providing site supervisor(s) with work assignments and overseeing their
performance; coordinating safety and health efforts with the SSHO; ensuring effective emergency response through
coordination with the Emergency Response Coordinator (ERC); serving as primary site liaison with public agencies and
officials and site contractors.
The qualified alternate Project Manager (PM) for this site is Ben Ashba.
Project Manager (PM)
The Site Safety and Health Officer (SSHO) for this site is TBD. The SSHO has full responsibility and authority to develop
and implement this HASP and to verify compliance. The SSHO reports to the Project Manager. The SSHO is on site or
readily accessible to the site during all work operations and has the authority to halt site work if unsafe conditions are
detected. The specific responsibilities of the SSHO are:
Managing the safety and health functions on this site; serving as the site’s point of contact for safety and health matters;
ensuring site monitoring, worker training, and effective selection and use of PPE; assessing site conditions for unsafe acts
and conditions and providing corrective action; assisting the preparation and review of this HASP; maintaining effective
safety and health records as described in this HASP; coordinating with the Emergency Response Coordinator (ERC), Site
Supervisor(s), and others as necessary for safety and health efforts.
Site Safety and Health Officer (SSHO)
1 - 1 of 4 Date of Program:Site Name:Former Texaco Food Mart
1.2 Identification of Other Site Contractors
Safety and health lines of communication with these contractors are illustrated in Figure 1-1.
The other contractors and subcontractors on this site who could be affected by the tasks and operations associated with
this workplan and HASP are listed in Table 1-2 below.
Company Function
Table 1-2 Other Site Contractors and Subcontractors
TBD
The Emergency Response Coordinator (ERC) for this site is TBD. The ERC is responsible for assessing site conditions
and directing and controlling emergency response activities in accordance with the Site Emergency Response Plan. The
ERC reports to the Project Manager (PM). The ERC will ensure the evacuation, emergency transport, and treatment of
site personnel and will notify the appropriate emergency response units and management staff in accordance with the
emergency response plan of this HASP. Specific duties of the ERC include:
Developing and reviewing the emergency response plan; conducting emergency response rehearsals; ensuring effective
emergency response to and evacuation of the site; coordinating emergency response functions with the Site Safety and
Health Officer (SSHO), and integrating site emergency response plans with the disaster, fire, and/or emergency response
plans of local, state, and federal organizations and agencies.
Emergency Response Coordinator (ERC)
The Site Supervisor for this site is TBD. The Site Supervisor is responsible for field operations and reports to the Project
Manager (PM). The Site Supervisor ensures the implementation of the HASP requirements and procedures in the field.
The specific responsibilities of the Site Supervisor are:
Executing the work plan and schedule as detailed by the PM; coordination with the Site Safety and Health Officer (SSHO)
on safety and health; ensuring site work compliance with the requirements of this HASP.
Site Supervisor
Site workers are responsible for complying with this HASP, using the proper PPE, reporting unsafe acts and conditions,
and following the work and safety and health instructions of the Project Manager (PM), Site Safety and Health Officer
(SSHO), and Site Supervisor.
Site Workers
1 - 2 of 4 Date of Program:Site Name:Former Texaco Food Mart
1.3 Other local/State/Federal Agency Representatives and Their Roles Responsibilities
1 - 3 of 4 Date of Program:Site Name:Former Texaco Food Mart
Figure 1-1 Organizational Chart
Insert the site organizational chart here, showing S&H lines of authority and communication among site contractors.
1 - 4 of 4 Date of Program:Site Name:Former Texaco Food Mart
CONTRACT MANAGER
Benjamin J. Ashba, PG
CONTRACT QUALITY
ASSURANCE
Michael E. Mason, PEACCOUNTING AND COST
CONTROL SUPPORT

ENGINEERING TEAM
Michael E. Mason, PE
Jason R. Catlin, PE
Nicole L. Hall, PE
Joshua Norris, PE
Ben D. Lackey, PE
M. Robin Austin, PE, LEED AP
Cindy Liu, PhD, PE
Fowler Del Porto, PE, LEED AP
Matthew Aupperle, EI
FIELD SUPPORT TEAM
William Miller, CWC
Tommy Chalmers, CWC
Corey Futral, CWC
Stuart Bowman, CWC
Jordan Edmondson
Patrick McCain
Eddie Swain
Larry Wessell
Robert Baldwin, PG
Trevor Mizelle
Nate Newman
AutoCAD / GIS
Jeffery A. Roney
Buster Whitfield
Adrienne Willis
Karly Ulfsax
Brandon Hinkle
AutoCAD / GIS
Jeffery A. Roney
Buster Whitfield
Adrienne Willis
Karly Ulfsax
Brandon Hinkle

ASSESSMENT TEAM
Steve Hudson, PG, CWC
Lee Stone, PG
Corey Futral, CWC
Lindsay Pugh, PG
Kyle Swain
Stacey Martin
Jeffery Wilson
Abby Wesley
Sandy Miller
GEOTECHNICAL
LABORATORY
Michael D. Mason
Olivia Daynes
GEOTECHNICAL
LABORATORY
Michael D. Mason
Olivia Daynes
PROJECT MANAGERS
Sean J. O’Neil, PE
Shane Chasteen, PG
William J. Walsh, PE
2.0 JOB HAZARD ANALYSIS
(in compliance with 29 CFR 1910.120(b)(4)(ii)(A),and 1910.120(i))
This chapter of the HASP describes the safety and health hazards associated with site work and the control measures
selected to protect workers. The purpose of a job hazard analysis (JHA) is to identify and quantify the health and safety
hazards associated with each site task and operation, and to evaluate the risks to workers. Using this information,
appropriate control methods are selected to eliminate the identified risks if possible, or to effectively control them. The
control methods are documented in each task-specific JHA. The information contained in this chapter is essential to
effective preparation of all other chapters of the HASP. This section of the HASP includes:
2.1 Site History
The following text describes the site and its conditions as they relate to the need to perform hazardous substance clean-
up operations.
* a site description
* job hazard analysis
* hazardous substance information
* employee notification of hazards
2.2 Job Hazard Analysis
Health hazard information for all chemical substance identified in site JHAs appears in hazard data sheets attached to this
chapter.
The person responsible for ongoing job hazard analysis at this site is Sean O'Neil or Ben Ashba.
The site is currently vacant and most recently operated as a CITGO gas station. In 1999 a Preliminary Site Assessment
identified 5 USTs and found groundwater and soil samples to contain petroleum contaminants. Two water supply wells
were identified within 1,000 feet. Several monitoring events occurred over the years, identifiying contaminants above 2L
exceedances in all monitoring wells except MW-2, which exceeded GCL as well. In 2012 a soil boring (SB-8) was put in
near the western dispenser island. From 2013 to 2015 bi-weekly air sparging events were conducted. In 2018, six USTs
were closed and removed. TPH was not detected in sample collected from bottom of kerosene tank basin. No free
product has been reported at this site.
The sources used to provide the above description include:
Sean O'Neil modifies site-specific JHAs and the accompanying data sheets when:
* the scope of work is changed by adding, eliminating, or modifying tasks
* new methods of performing site tasks are selected
* observation of the performance of site tasks results in a revised characterization of the hazards
* new chemical, biological, or physical hazards are identified
* exposure data indicate changes in the concentration and/or likelihood of exposure
* new/different control measures are selected
Each site-specific JHA appears on a separate copy of Table 2-2. Each JHA lists a task or operation required during site
clean-up and the location(s) where that task or operation is performed. A single JHA may be used for a task/operation
performed in multiple locations if the hazards, potential exposures, and controls are the same in each location.
Each JHA lists the chemical hazards associated with that task and their known or anticipated airborne concentrations
during performance of the task. Each JHA also identifies anticipated physical and biological hazards and potential
exposure levels or the likelihood of exposure. The final section of each JHA lists the control measures implemented to
protect employees from exposure to the identified hazards. The information provided here is designed to satisfy the job
hazard analysis requirements of 1910.120(b)(4)(ii)(A) and the workplace hazard assessment requirements of 1910.132(d).
When JHAs are modified, related provisions in other chapters of this HASP are modified as needed.
NCDEQ Memo
2 - 1 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Table 2-2: Site-Specific Job Hazard Analysis
Operational
Phase
Task/Operation Location Where Task/Operation
Performed
Monitoring Groundwater sampling Nine (9) MWs at subject site and adjacant
parcels
Date(s) this JHA
Conducted
Employee Certifying this JHA
TBD
Print Name Signature
Phase
No
Control Measures Used
Level of PPE:
PPE Upgrade: No Data Entered
PPE Downgrade: No Data
Entered
2 - 2 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Table 2-2: Site-Specific Job Hazard Analysis
Operational
Phase
Task/Operation Location Where Task/Operation
Performed
Monitoring Sample Montoring Well Subject Site
Date(s) this JHA
Conducted
Employee Certifying this JHA
TBD
Print Name Signature
01/13/2021
Phase
No
Exposure LimitChemical Name Source Concentration
Chemical Hazards
Groundwater ppm 0.5 ppm TLV-TWA ACGIHBENZENE
Groundwater ppm 100 ppm TLV-TWA ACGIHETHYL BENZENE
Groundwater ppm 20 ppm TLV-TWA ACGIHTOLUENE
Groundwater ppm 100 ppm TLV-TWA ACGIHXYLENE, ALL ISOMERS
Groundwater ppm 50 ppm TLV-TWA ACGIHMETHYL TERT-BUTYL ETHER
Groundwater ppm 10 ppm TLV-TWA ACGIHNAPHTHALENE
* Chemicals added by user
Exposure Level/
Potential
Name of Physical Hazard Exposure LimitSource
Physical Hazards
N/AatmosphereLikelyCold Weather Operations
N/AatmosphereLikelyHeat (ambient)
N/AsurroundingsLikelySlips/Trips/Falls
Source Exposure PotentialName of Biological Hazard
Biological Hazards
surroundings LikelyInsect bites and stings
surroundings LikelySnakes
surroundings LikelyPoison Plants (Ivy, Oak, and/or
Sumac)
surroundings LikelyLyme Disease - Ticks
2 - 3 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Control Measures Used
Engineering Controls: See SOPs in Chapter 12
Work Practices: See SOPs in Chapter 12
Level of PPE: D Respirator Cartridge/Canister: Not Applicable
Service Life: Not Applicable
PPE Upgrade: No
PPE Downgrade: No
2 - 4 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Table 2-2: Site-Specific Job Hazard Analysis
Operational
Phase
Task/Operation Location Where Task/Operation
Performed
Monitoring Site survey within 1,500 feet of site
Date(s) this JHA
Conducted
Employee Certifying this JHA
TBD
Print Name Signature
Phase
No
Control Measures Used
Level of PPE:
PPE Upgrade: No Data Entered
PPE Downgrade: No Data
Entered
2 - 5 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Table 2-2: Site-Specific Job Hazard Analysis
Operational
Phase
Task/Operation Location Where Task/Operation
Performed
Monitoring Top of Casing Survey
Date(s) this JHA
Conducted
Employee Certifying this JHA
TBD
Print Name Signature
Phase
No
Control Measures Used
Level of PPE:
PPE Upgrade: No Data Entered
PPE Downgrade: No Data
Entered
2 - 6 of 19 Date of Program:Site Name:Former Texaco Food Mart #
2.3 Employee Notification of Hazards and Overall Site Information Program
The information in the JHAs and the attached data sheets is made available to all employees who could be affected by it
prior to the time they begin their work activities. Modifications to JHAs and the accompanying data sheets are
communicated during routine briefings.
Consistent with paragraph (i) of HAZWOPER, we also inform other contractors and subcontractors about the nature and
level of hazardous substances at this site, and the likely degree of exposure to workers who participate in site operations.
For purposes of this HASP and all future project sites, Benzene and Lead constituents will be included, at a minimum, as
potential health risks.
The person responsible for providing site information, this HASP, and any modifications to the HASP to other contractors
and subcontractors working on this site is: TBD
2.4 Container Labeling
Labels and other forms of warning shall be in accordance with 29 CFR 1910.1200(f) and its subsections.
2 - 7 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Chemical Name: BENZENE
CAS #: 71-43-2 Formula: C6H6UN No: 1114
CHEMICAL IDENTIFICATION
PHYSICAL PROPERTIES
176ºF
42ºF
78.1
Physical Description: Colorless to light-yellow liquid with an aromatic odor. [Note: A solid below 42ºF.]
75 mmHg
3
2
0
NA
EXPOSURE GUIDELINES
1
OSHA NIOSH ACGIH Related Information
3
5
15
NA
NA
Notes: SEE 29 CFR
1910.1028, FOR
INDUSTRIES EXEMPT
FROM THIS STANDARD
THE PELs ARE LOCATED
IN 29 CFR 1910.1000 TABLE
Z-2 (8-HR TWA=10 ppm,
C=25ppm, PEAK=50ppm
FOR A 10 MINUTE
INTERVAL DURING AN 8-
0.32
1
3.2
NA
NA
Notes: CARCINOGEN (Ca)
0.5
1.6
2.5
8
NA
NA
Notes: BEI,SKIN
IDLH ppm: 500 IDLH mg/m3: NA
AIHA Emergency Response
Planning Guidelines
(ERPGs)EPRG-1/EPRG-
2/EPRG-3: 50 ppm/150
ppm/1000 ppm
Carcinogen Classifications:
IARC-1, NIOSH-Ca, NTP-K,
OSHA-Ca, TLV-A1, EPA-K
IDLH Notes: Ca
HEALTH INFORMATION
Symptoms: eye, nose, respiratory system irritation; giddiness; headaches; nausea; staggered gait; fatigue; anorexia; lassitude;
dermatitis; bone marrow depression; [carcinogenic]
Health Effects: suspect leukemogen; cumulative bone marrow damage; TDlo (oral, human) 130 mg/mg
Target Organ: eyes, skin, respiratory system, blood, central nervous system, bone marrow
EMERGENCY RESPONSE INFORMATION
First Aid: EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal
saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments,
oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim
after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop. SKIN: IMMEDIATELY flood
affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly
with soap and water. IMMEDIATELY call a hospital or poison control center even if no symptoms (such as redness or
irritation) develop. IMMEDIATELY transport the victim to a hospital for treatment after washing the affected areas.
INHALATION: IMMEDIATELY leave the contaminated area; take deep breaths of fresh air. IMMEDIATELY call a
Synonyms: Benzol, Phenyl hydride
0.88
12ºF
1.2%
7.8%
9.24 eV
NA
Skin Notation:
0.1REL-TWA ppm:
REL-TWA mg/m3:
REL-STEL ppm:
REL-STEL mg/m3:
REL-C ppm:
REL-C mg/m3:
PEL-TWA ppm:
PEL-TWA mg/m3:
PEL-STEL ppm:
PEL-STEL mg/m3:
PEL-C ppm:
PEL-C mg/m3:
TLV-TWA ppm:
TLV-TWA mg/m3:
TLV-STEL ppm:
TLV-STEL mg/m3:
TLV-C ppm:
TLV-C mg/m3:
BP:
MLT:
Fl.P:
Sp. Gr.:
MW:
VP:
VD:
IP:
LEL:
UEL:
NFPA Fire Rating:
NFPA Health Rating:
NFPA Reactivity Rating:
NFPA Sp. Inst.:
2 - 8 of 19 Date of Program:Site Name:Former Texaco Food Mart #
physician and be prepared to transport the victim to a hospital even if no symptoms (such as wheezing, coughing, shortness of
breath, or burning in the mouth, throat, or chest) develop. Provide proper respiratory protection to rescuers entering an unknown
atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not available, use a level of
protection greater than or equal to that advised under Protective Clothing. INGESTION: DO NOT INDUCE VOMITING.
Volatile chemicals have a high risk of being aspirated into the victim's lungs during vomiting which increases the medical
problems. If the victim is conscious and not convulsing, give 1 or 2 glasses of water to dilute the chemical and IMMEDIATELY
call a hospital or poison control center. IMMEDIATELY transport the victim to a hospital. If the victim is convulsing or
unconscious, do not give anything by mouth, ensure that the victim's airway is open and lay the victim on his/her side with the
head lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY transport the victim to a hospital. OTHER:
Since this chemical is a known or suspected carcinogen you should contact a physician for advice regarding the possible long
term health effects and potential recommendation for medical monitoring. Recommendations from the physician will depend
upon the specific compound, its chemical, physical and toxicity properties, the exposure level, length of exposure, and the route
of exposure. (NTP, 1992)
Reactivity: CHEMICAL PROFILE: Allyl chloride or other alkyl halides will react vigorously with benzene or toluene, even at
minus 70C. in the presence of ethyl aluminum dichloride or ethyl aluminum sesquichloride. Explosions have been reported
(NFPA 491M 1991). Benzene ignites in contact with the powdered chromic anhydride (Mellor 11:235 1946-47).
(REACTIVITY, 1999)
Nonfire Spill Response: Keep sparks, flames, and other sources of ignition away. Keep material out of water sources and
sewers. Build dikes to contain flow as necessary. Attempt to stop leak if without undue personnel hazard. Use water spray to
knock-down vapors. ( AAR, 1999)
Fire Response: Do not extinguish fire unless flow can be stopped. Use water in flooding quantities as fog. Solid streams of
water may spread fire. Cool all affected containers with flooding quantities of water. Apply water from as far a distance as
possible. Use foam, dry chemical, or carbon dioxide. ( AAR, 1999)
2 - 9 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Chemical Name: ETHYL BENZENE
CAS #: 100-41-4 Formula: C8H10UN No: 1175
CHEMICAL IDENTIFICATION
PHYSICAL PROPERTIES
277ºF
-139ºF
106.2
Physical Description: Colorless liquid with an aromatic odor.
7 mmHg
3
2
0
NA
EXPOSURE GUIDELINES
100
OSHA NIOSH ACGIH Related Information
435
NA
NA
NA
NA
Notes: NA
435
125
545
NA
NA
Notes: NA
100
434
125
543
NA
NA
Notes: BEI
IDLH ppm: 800 IDLH mg/m3: NA
AIHA Emergency Response
Planning Guidelines
(ERPGs)EPRG-1/EPRG-
2/EPRG-3: NA
Carcinogen Classifications:
IARC-2B, TLV-A3, EPA-D
IDLH Notes: 10% of LEL
HEALTH INFORMATION
Symptoms: eye, mucous membrane irritation; headaches; dermatitis; narcosis; coma
Health Effects: irritation-eye, nose, throat, skin---moderate; narcosis
Target Organ: eyes, skin, respiratory system, central nervous system
EMERGENCY RESPONSE INFORMATION
First Aid: EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal
saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments,
oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim
after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop. SKIN: IMMEDIATELY flood
affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly
with soap and water. If symptoms such as redness or irritation develop, IMMEDIATELY call a physician and be prepared to
transport the victim to a hospital for treatment. INHALATION: IMMEDIATELY leave the contaminated area; take deep
breaths of fresh air. If symptoms (such as wheezing, coughing, shortness of Breathing, or burning in the mouth, throat, or chest)
develop, call a physician and be prepared to transport the victim to a hospital. Provide proper respiratory protection to rescuers
entering an unknown atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not
Synonyms: Ethylbenzol, Phenylethane
0.87
55ºF
0.8%
6.7%
8.76 eV
NA
Skin Notation:
100REL-TWA ppm:
REL-TWA mg/m3:
REL-STEL ppm:
REL-STEL mg/m3:
REL-C ppm:
REL-C mg/m3:
PEL-TWA ppm:
PEL-TWA mg/m3:
PEL-STEL ppm:
PEL-STEL mg/m3:
PEL-C ppm:
PEL-C mg/m3:
TLV-TWA ppm:
TLV-TWA mg/m3:
TLV-STEL ppm:
TLV-STEL mg/m3:
TLV-C ppm:
TLV-C mg/m3:
BP:
MLT:
Fl.P:
Sp. Gr.:
MW:
VP:
VD:
IP:
LEL:
UEL:
NFPA Fire Rating:
NFPA Health Rating:
NFPA Reactivity Rating:
NFPA Sp. Inst.:
2 - 10 of 19 Date of Program:Site Name:Former Texaco Food Mart #
available, use a level of protection greater than or equal to that advised under Protective Clothing. INGESTION: DO NOT
INDUCE VOMITING. If the victim is conscious and not convulsing, give 1 or 2 glasses of water to dilute the chemical and
IMMEDIATELY call a hospital or poison control center. Be prepared to transport the victim to a hospital if advised by a
physician. If the victim is convulsing or unconscious, do not give anything by mouth, ensure that the victim's airway is open and
lay the victim on his/her side with the Headache lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY
transport the victim to a hospital. (NTP, 1992)
Reactivity: STABILITY: This chemical is stable under normal laboratory conditions. Solutions of this chemical should be
stable for 24 hours under normal lab conditions.REACTIVITY: This compound can react vigorously with strong oxidizing
materials. (NTP, 1992)
Nonfire Spill Response: Keep sparks, flames, and other sources of ignition away. Keep material out of water sources and
sewers. Build dikes to contain flow as necessary. Attempt to stop leak if without undue personnel hazard. Use water spray to
knock-down vapors. Land spill: Dig a pit, pond, lagoon, holding area to contain liquid or solid material. Dike surface flow
using soil, sand bags, foamed polyurethane, or foamed concrete. Absorb bulk liquid with fly ash, cement powder, or commercial
sorbents. Apply "universal" gelling agent to immobilize spill. Apply approriate foam to diminish vapor and fire hazard. Water
spill: Use natural barriers or oil spill control booms to limit spill travel. Use surface active agent (e.g. detergent, soaps,
alcohols), if approved by epa. Inject "universal" gelling agent to solidify encircled spill and increase effectiveness of booms. If
dissolved, in region of 10 ppm or greater concentration, apply activated carbon at ten times the spilled amount. Remove trapped
material with suction hoses. Use mechanical dredges or lifts to remove immobilized masses of pollutants and precipitates. (
AAR, 1999)
Fire Response: Do not extinguish fire unless flow can be stopped. Use water in flooding quantities as fog. Solid streams of
water may spread fire. Cool all affected containers with flooding quantities of water. Apply water from as far a distance as
possible. Use foam, dry chemical, or carbon dioxide. ( AAR, 1999)
2 - 11 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Chemical Name: METHYL TERT-BUTYL ETHER
CAS #: 1634-04-4 Formula: C5H12OUN No: 2398
CHEMICAL IDENTIFICATION
PHYSICAL PROPERTIES
55.2
NA
88.17
Physical Description:
NA
NA
NA
NA
NA
EXPOSURE GUIDELINES
NA
OSHA NIOSH ACGIH Related Information
NA
NA
NA
NA
NA
Notes: NA
NA
NA
NA
NA
NA
Notes: NA
50
180
NA
NA
NA
NA
Notes: NA
IDLH ppm: NA IDLH mg/m3: NA
AIHA Emergency Response
Planning Guidelines
(ERPGs)EPRG-1/EPRG-
2/EPRG-3: NA
Carcinogen Classifications:
IARC-3, TLV-A3
IDLH Notes: NA
HEALTH INFORMATION
Symptoms: NA
Health Effects: NA
Target Organ: NA
EMERGENCY RESPONSE INFORMATION
First Aid: INHALATION: Move victim to fresh air; call emergency medical care. If not breathing, give artificial respiration. If
breathing is difficult, give oxygen. EYES OR SKIN: Flush with running water for at least 15 minutes; hold eyelids open if
necessary. Remove and isolate contaminated clothing and shoes at the site. Keep victim quiet and maintain normal body
temperature. INGESTION: If victim is unconscious or having convulsions, do nothing except keep victim warm. (USCG, 1999)
Reactivity: CHEMICAL PROFILE: Oxidizes readily in air to form unstable peroxides that may explode spontaneously
(Bretherick 1979. p.151-154, 164). A mixture of liquid air and diethyl ether exploded spontaneously (MCA Case History 616.
1960). (REACTIVITY, 1999)
Nonfire Spill Response: Keep sparks, flames, and other sources of ignition away. Keep material out of water sources and
sewers. Build dikes to contain flow as necessary. Use water spray to knock-down vapors. ( AAR, 1999)
Synonyms: NA
NA
NA
NA
NA
NA
NA
Skin Notation:
NAREL-TWA ppm:
REL-TWA mg/m3:
REL-STEL ppm:
REL-STEL mg/m3:
REL-C ppm:
REL-C mg/m3:
PEL-TWA ppm:
PEL-TWA mg/m3:
PEL-STEL ppm:
PEL-STEL mg/m3:
PEL-C ppm:
PEL-C mg/m3:
TLV-TWA ppm:
TLV-TWA mg/m3:
TLV-STEL ppm:
TLV-STEL mg/m3:
TLV-C ppm:
TLV-C mg/m3:
BP:
MLT:
Fl.P:
Sp. Gr.:
MW:
VP:
VD:
IP:
LEL:
UEL:
NFPA Fire Rating:
NFPA Health Rating:
NFPA Reactivity Rating:
NFPA Sp. Inst.:
2 - 12 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Fire Response: Do not extinguish fire unless flow can be stopped. Use water in flooding quantities as fog. Solid streams of
water may spread fire. Cool all affected containers with flooding quantities of water. Apply water from as far a distance as
possible. Use foam, dry chemical, or carbon dioxide. ( AAR, 1999)
2 - 13 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Chemical Name: NAPHTHALENE
CAS #: 91-20-3 Formula: C10H8UN No: 1334
CHEMICAL IDENTIFICATION
PHYSICAL PROPERTIES
424ºF
165 to 176ºF
128.2
Physical Description: Colorless to brown solid with an odor of mothballs. [Note: Shipped as a molten solid.]
0.08 mmHg
2
2
0
NA
EXPOSURE GUIDELINES
10
OSHA NIOSH ACGIH Related Information
50
NA
NA
NA
NA
Notes: NA
50
15
75
NA
NA
Notes: NA
10
52
15
79
NA
NA
Notes: SKIN
IDLH ppm: 250 IDLH mg/m3: NA
AIHA Emergency Response
Planning Guidelines
(ERPGs)EPRG-1/EPRG-
2/EPRG-3: NA
Carcinogen Classifications:
TLV-A4, EPA-CBD, NTP-R
IDLH Notes: NA
HEALTH INFORMATION
Symptoms: eye irritation; headaches; confusion, excitement, malaise; nausea, vomiting, abdominal pain; bladder irritation;
profuse sweating; jaundice; hematuria, hemoglobinuria, renal shutdown; dermatitis
Health Effects: irritation-eye, nose, throat, skin---marked; ocular damage/anemia/central nervous system damage
Target Organ: eyes, skin, blood, liver, kidneys, central nervous system
EMERGENCY RESPONSE INFORMATION
First Aid: EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal
saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments,
oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim
after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop. SKIN: IMMEDIATELY flood
affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly
with soap and water. IMMEDIATELY call a hospital or poison control center even if no symptoms (such as redness or
irritation) develop. IMMEDIATELY transport the victim to a hospital for treatment after washing the affected areas.
INHALATION: IMMEDIATELY leave the contaminated area; take deep breaths of fresh air. IMMEDIATELY call a
physician and be prepared to transport the victim to a hospital even if no symptoms (such as wheezing, coughing, shortness of
Synonyms: Naphthalin, Tar camphor, White tar
1.15
174ºF
0.9%
5.9%
8.12 eV
NA
Skin Notation:
10REL-TWA ppm:
REL-TWA mg/m3:
REL-STEL ppm:
REL-STEL mg/m3:
REL-C ppm:
REL-C mg/m3:
PEL-TWA ppm:
PEL-TWA mg/m3:
PEL-STEL ppm:
PEL-STEL mg/m3:
PEL-C ppm:
PEL-C mg/m3:
TLV-TWA ppm:
TLV-TWA mg/m3:
TLV-STEL ppm:
TLV-STEL mg/m3:
TLV-C ppm:
TLV-C mg/m3:
BP:
MLT:
Fl.P:
Sp. Gr.:
MW:
VP:
VD:
IP:
LEL:
UEL:
NFPA Fire Rating:
NFPA Health Rating:
NFPA Reactivity Rating:
NFPA Sp. Inst.:
2 - 14 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Breathing, or burning in the mouth, throat, or chest) develop. Provide proper respiratory protection to rescuers entering an
unknown atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not available, use a
level of protection greater than or equal to that advised under Protective Clothing. INGESTION: If the victim is conscious and
not convulsing, give 1 or 2 glasses of water to dilute the chemical and IMMEDIATELY call a hospital or poison control center.
Generally, the induction of vomiting is NOT recommended outside of a physician's care due to the risk of aspirating the
chemical into the victim's lungs. However, if the victim is conscious and not convulsing and if medical help is not readily
available, consider the risk of inducing vomiting because of the high toxicity of the chemical ingested. Ipecac syrup or salt water
may be used in such an emergency. IMMEDIATELY transport the victim to a hospital. If the victim is convulsing or
unconscious, do not give anything by mouth, ensure that the victim's airway is open and lay the victim on his/her side with the
Headache lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY transport the victim to a hospital. (NTP,
1992)
Reactivity: CHEMICAL PROFILE: Naphthalene, camphor, glycerol, or turpentine will react violently with chromic anhydride
(Haz. Chem. Data 1967. p 68). (REACTIVITY, 1999)
Nonfire Spill Response: Keep sparks, flames, and other sources of ignition away. Keep material out of water sources and
sewers. Build dikes to contain flow as necessary. Land spill: Dig a pit, pond, lagoon, holding area to contain liquid or solid
material. Cover solids with a plastic sheet to prevent dissolving in rain or fire fighting water. Water spill: Use natural deep
water pockets, excavated lagoons, or sand bag barriers to trap material at bottom. If dissolved, in region of 10 ppm or greater
concentration, apply activated carbon at ten times the spilled amount. Remove trapped material with suction hoses. Use
mechanical dredges or lifts to remove immobilized masses of pollutants and precipitates. ( AAR, 1999)
Fire Response: Do not extinguish fire unless flow can be stopped. Use water in flooding quantities as fog. Cool all affected
containers with flooding quantities of water. Apply water from as far a distance as possible. Solid streams of water may be
ineffective. Use "alcohol" foam, dry chemical or carbon dioxide. ( AAR, 1999)
2 - 15 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Chemical Name: TOLUENE
CAS #: 108-88-3 Formula: C7H8UN No: 1294
CHEMICAL IDENTIFICATION
PHYSICAL PROPERTIES
232ºF
-139ºF
92.1
Physical Description: Colorless liquid with a sweet, pungent, benzene-like odor.
21 mmHg
3
2
0
NA
EXPOSURE GUIDELINES
200
OSHA NIOSH ACGIH Related Information
NA
NA
300
NA
NA
Notes: PEAK = 500 ppm FOR
A 10 MINUTE INTERVAL
DURING AN 8-HOUR SHIFT
375
150
560
NA
NA
Notes: NA
20
75
NA
NA
NA
NA
Notes: NA
IDLH ppm: 500 IDLH mg/m3: NA
AIHA Emergency Response
Planning Guidelines
(ERPGs)EPRG-1/EPRG-
2/EPRG-3: 50 ppm/300
ppm/1000 ppm
Carcinogen Classifications:
IARC-3, TLV-A4, EPA-NL
IDLH Notes: NA
HEALTH INFORMATION
Symptoms: fatigue, weakness; confusion, euphoria, dizziness; headaches; dilated pupils, lacrimation; nervousness; muscle
fatigue; insomnia; paresthesia; dermatitis
Health Effects: irritation-eye, nose, throat, skin---moderate; narcosis;
Target Organ: eyes, skin, respiratory system, central nervous system, liver, kidneys
EMERGENCY RESPONSE INFORMATION
First Aid: EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal
saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments,
oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim
after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop. SKIN: IMMEDIATELY flood
affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly
with soap and water. If symptoms such as redness or irritation develop, IMMEDIATELY call a physician and be prepared to
transport the victim to a hospital for treatment. INHALATION: IMMEDIATELY leave the contaminated area; take deep
breaths of fresh air. If symptoms (such as wheezing, coughing, shortness of Breathing, or burning in the mouth, throat, or chest)
develop, call a physician and be prepared to transport the victim to a hospital. Provide proper respiratory protection to rescuers
Synonyms: Methyl benzene, Methyl benzol, Phenyl methane, Toluol
0.87
40ºF
1.1%
7.1%
8.82 eV
NA
Skin Notation:
100REL-TWA ppm:
REL-TWA mg/m3:
REL-STEL ppm:
REL-STEL mg/m3:
REL-C ppm:
REL-C mg/m3:
PEL-TWA ppm:
PEL-TWA mg/m3:
PEL-STEL ppm:
PEL-STEL mg/m3:
PEL-C ppm:
PEL-C mg/m3:
TLV-TWA ppm:
TLV-TWA mg/m3:
TLV-STEL ppm:
TLV-STEL mg/m3:
TLV-C ppm:
TLV-C mg/m3:
BP:
MLT:
Fl.P:
Sp. Gr.:
MW:
VP:
VD:
IP:
LEL:
UEL:
NFPA Fire Rating:
NFPA Health Rating:
NFPA Reactivity Rating:
NFPA Sp. Inst.:
2 - 16 of 19 Date of Program:Site Name:Former Texaco Food Mart #
entering an unknown atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not
available, use a level of protection greater than or equal to that advised under Protective Clothing. INGESTION: DO NOT
INDUCE VOMITING. If the victim is conscious and not convulsing, give 1 or 2 glasses of water to dilute the chemical and
IMMEDIATELY call a hospital or poison control center. Be prepared to transport the victim to a hospital if advised by a
physician. If the victim is convulsing or unconscious, do not give anything by mouth, ensure that the victim's airway is open and
lay the victim on his/her side with the Headache lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY
transport the victim to a hospital. (NTP, 1992)
Reactivity: CHEMICAL PROFILE: Allyl chloride or other alkyl halides will react vigorously with benzene or toluene, even at
minus 70 C in the presence of ethyl aluminum dichloride or ethyl aluminum sesquichloride. Explosions have been reported
(NFPA 491M 1991). (REACTIVITY, 1999)
Nonfire Spill Response: Keep sparks, flames, and other sources of ignition away. Keep material out of water sources and
sewers. Build dikes to contain flow as necessary. Attempt to stop leak if without undue personnel hazard. Use water spray to
knock-down vapors. Land spill: Dig a pit, pond, lagoon, holding area to contain liquid or solid material. Dike surface flow
using soil, sand bags, foamed polyurethane, or foamed concrete. Absorb bulk liquid with fly ash, cement powder, or commercial
sorbents. Apply "universal" gelling agent to immobilize spill. Apply approriate foam to diminish vapor and fire hazard. Water
spill: Use natural barriers or oil spill control booms to limit spill travel. Use surface active agent (e.g. detergent, soaps,
alcohols), if approved by epa. Inject "universal" gelling agent to solidify encircled spill and increase effectiveness of booms. If
dissolved, in region of 10 ppm or greater concentration, apply activated carbon at ten times the spilled amount. Remove trapped
material with suction hoses. Use mechanical dredges or lifts to remove immobilized masses of pollutants and precipitates. (
AAR, 1999)
Fire Response: Do not extinguish fire unless flow can be stopped. Use water in flooding quantities as fog. Solid streams of
water may spread fire. Cool all affected containers with flooding quantities of water. Apply water from as far a distance as
possible. Use foam, dry chemical, or carbon dioxide. ( AAR, 1999)
2 - 17 of 19 Date of Program:Site Name:Former Texaco Food Mart #
Chemical Name: XYLENE, ALL ISOMERS
CAS #: 1330-20-7 Formula: C8H10UN No: 1307
CHEMICAL IDENTIFICATION
PHYSICAL PROPERTIES
281ºF
-12/-54/55ºF
106.2
Physical Description: Colorless liquid with an aromatic odor. [Note: A solid below 56ºF.]
9 mmHg
3
2
0
NA
EXPOSURE GUIDELINES
100
OSHA NIOSH ACGIH Related Information
435
NA
NA
NA
NA
Notes: NA
435
150
655
NA
NA
Notes: NA
100
434
150
651
NA
NA
Notes: BEI
IDLH ppm: 900 IDLH mg/m3: NA
AIHA Emergency Response
Planning Guidelines
(ERPGs)EPRG-1/EPRG-
2/EPRG-3: NA
Carcinogen Classifications:
IARC-3, TLV-A4, EPA-D; I
IDLH Notes: NA
HEALTH INFORMATION
Symptoms: irritation eyes, skin, nose, throat; dizziness, excitement, drowsiness, incoordination, staggering gait; corneal
vacuolization; anorexia, nausea, vomiting, abdominal pain; dermatitis
Health Effects: irritation-eye, nose, throat, skin---moderate; narcosis;
Target Organ: eyes, skin, respiratory system, central nervous system, gastrointestinal tract, blood, liver, kidneys
EMERGENCY RESPONSE INFORMATION
First Aid: EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal
saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments,
oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim
after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop. SKIN: IMMEDIATELY flood
affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly
with soap and water. If symptoms such as redness or irritation develop, IMMEDIATELY call a physician and be prepared to
transport the victim to a hospital for treatment. INHALATION: IMMEDIATELY leave the contaminated area; take deep
breaths of fresh air. If symptoms (such as wheezing, coughing, shortness of Breathing, or burning in the mouth, throat, or chest)
develop, call a physician and be prepared to transport the victim to a hospital. Provide proper respiratory protection to rescuers
Synonyms: 1,2(3 or 4)-Dimethylbenzene, ortho(meta or para)-Xylene, o(m or p)-Xylol
0.86-0.88
81-90ºF
0.9-1.1%
6.7-7.0%
8.44-8.56 eV
NA
Skin Notation:
100REL-TWA ppm:
REL-TWA mg/m3:
REL-STEL ppm:
REL-STEL mg/m3:
REL-C ppm:
REL-C mg/m3:
PEL-TWA ppm:
PEL-TWA mg/m3:
PEL-STEL ppm:
PEL-STEL mg/m3:
PEL-C ppm:
PEL-C mg/m3:
TLV-TWA ppm:
TLV-TWA mg/m3:
TLV-STEL ppm:
TLV-STEL mg/m3:
TLV-C ppm:
TLV-C mg/m3:
BP:
MLT:
Fl.P:
Sp. Gr.:
MW:
VP:
VD:
IP:
LEL:
UEL:
NFPA Fire Rating:
NFPA Health Rating:
NFPA Reactivity Rating:
NFPA Sp. Inst.:
2 - 18 of 19 Date of Program:Site Name:Former Texaco Food Mart #
entering an unknown atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not
available, use a level of protection greater than or equal to that advised under Protective Clothing. INGESTION: DO NOT
INDUCE VOMITING. If the victim is conscious and not convulsing, give 1 or 2 glasses of water to dilute the chemical and
IMMEDIATELY call a hospital or poison control center. Be prepared to transport the victim to a hospital if advised by a
physician. If the victim is convulsing or unconscious, do not give anything by mouth, ensure that the victim's airway is open and
lay the victim on his/her side with the Headache lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY
transport the victim to a hospital. (NTP, 1992)
Reactivity: CHEMICAL PROFILE: Xylene reacts with sulfuric acid, nitric acid, and strong oxidants liberating heat. (Handling
Chemicals Safely 1980. p. 962). (REACTIVITY, 1999)
Nonfire Spill Response: Keep sparks, flames, and other sources of ignition away. Keep material out of water sources and
sewers. Build dikes to contain flow as necessary. Attempt to stop leak if without undue personnel hazard. Use water spray to
knock-down vapors. Land spill: Dig a pit, pond, lagoon, holding area to contain liquid or solid material. Dike surface flow
using soil, sand bags, foamed polyurethane, or foamed concrete. Absorb bulk liquid with fly ash, cement powder, or commercial
sorbents. Apply "universal" gelling agent to immobilize spill. Apply approriate foam to diminish vapor and fire hazard. Water
spill: Use natural barriers or oil spill control booms to limit spill travel. Use surface active agent (e.g. detergent, soaps,
alcohols), if approved by epa. Inject "universal" gelling agent to solidify encircled spill and increase effectiveness of booms. If
dissolved, in region of 10 ppm or greater concentration, apply activated carbon at ten times the spilled amount. Remove trapped
material with suction hoses. Use mechanical dredges or lifts to remove immobilized masses of pollutants and precipitates. (
AAR, 1999)
Fire Response: Do not extinguish fire unless flow can be stopped. Use water in flooding quantities as fog. Solid streams of
water may spread fire. Cool all affected containers with flooding quantities of water. Apply water from as far a distance as
possible. Use foam, dry chemical, or carbon dioxide. ( AAR, 1999)
2 - 19 of 19 Date of Program:Site Name:Former Texaco Food Mart #
3.0 SITE CONTROL
(in compliance with 29 CFR 1910.120(b)(4)(ii)(F) and 29 CFR 1910.120(d))
* a site map, indicating site perimeter and work zones
* site access procedures
* site security
TBD is responsible for evaluating site conditions and for verifying that the site control program functions effectively. The site control
program is updated regularly to reflect current site conditions, work operations, and procedures.
Access to this site is restricted to reduce the potential for exposure to its safety and health hazards. During hours of
site operation, site entry and exit is authorized only at the point(s) identified in Figure 3-1. Entry and exit at these
points is controlled by the following: Property Owner. When the site is not operating, access to the site is controlled
by the following: Property Owner.
This site control program is designed to reduce the spread of hazardous substances from contaminated areas to clean
areas, to identify and isolate contaminated areas of the site, to facilitate emergency evacuation and medical care, to prevent
unauthorized entry to the site, and to deter vandalism and theft. If a site is determined to be non-hazardous, based on level
and type of contaminants, then the PM will establish appropriate site control measures.
* site work zones including standard operating procedures
* both internal (on-site) and external communications
* use of the buddy system
3.1 Site Map
3. 2 Site Access
3.3 Site Security
A map of this site, showing site boundaries, designated work zones, and points of entry and exit is provided in Figure 3-1, at the
end of this chapter. Please note that this information will likely be added by the SSHO during the initial site visit and prior to start of
any work.
3.4 Site Work Zones (To be established by PM prior to start of any work)
Security at this site is maintained during both working hours and non-working hours to prevent unauthorized entry; removal of
contaminated material from the exclusion zone; exposure of unauthorized, unprotected people to site hazards; and increased
hazards due to vandalism and theft.
The site control program includes the elements specified in 29 CFR 1910.120(d) and provides the following site-specific
information:
Visitors to the site register with TBD, and are escorted at all times. Visitors are expected to comply with the
requirements of this HASP. Visitors who want to enter contaminated areas of the site must provide documentation
that they have the required training and medical evaluation and must receive a site-specific briefing about protecting
themselves from site hazards, recognizing site zones demarcations, and following emergency evacuation
procedures. PPE for visitors is provided by Not Applicable.
Security During Working Hours
Not Applicable is responsible for establishing and maintaining site security during working hours. This site takes the following
measures for security during working hours:
Security During Non-working Hours
Not Applicable is responsible for establishing and maintaining site security during non-working hours. The following measures
have been taken for security during non-working hours:
The site is monitored for changing conditions that may warrant adjustment of zone boundaries. Zone boundaries are adjusted as
necessary to protect personnel and clean areas. Whenever boundaries are adjusted, zone markings are also changed and
workers are immediately notified of the change.
This site is divided into three (3) major zones, described below and shown in Figure 3-1. Please note that dividing the site into three
zones may not be necessary pending level and type of contaminants. These zones are
Zone boundaries are clearly marked at all times and the flow of personnel among the zones is controlled.
characterized by presence or absence of biological and chemical hazards and the activities performed within them.
This is a private property and no security measures are enforced. 1.
This is a private property and they prevent unauthorized entry on their property. 2.
The local police department is used for site surveillance. 1.
Operations are outdoors and no entry into the residence is required. 2.
3 - 1 of 6 Date of Program : Site Name :Former Texaco Food Mart #
The following criteria were considered in establishing the site work zones:
Personnel in the Exclusion Zone will adhere to the following SOPs:
Personnel and equipment will enter and exit the Exclusion Zone from the designated access points in the Contamination Reduction
Zone (CRZ), shown in Figure 3-1.
Exclusion Zone
The Exclusion Zone is the area where hazardous substance is known or suspected to be present and pose the
greatest potential for exposure. Remediation operations (site clean-up) are performed in the Exclusion Zone. At this
site, the Exclusion Zone boundaries are marked with the following: CATLIN personnel determines boundaries when
on-site.
The CRZ is located between the Exclusion Zone and the Support Zone (clean zone). Its primary purpose is for
decontamination of workers and equipment. The CRZ also serves as a buffer between the Exclusion Zone and
Support Zone, to limit the potential for contamination to spread to the Support Zone and outlying areas. At this site,
the CRZ boundaries are marked with CATLIN personnel determines boundaries when on-site..
Contamination Reduction Zone (CRZ)
Exclusion Zone (ExZ) SOPs
Based on monitoring results, the CRZ boundaries may be adjusted to ensure that the Support Zone remains uncontaminated.
Required clean-up activities. 1.
Sampling results for air and surface contaminants. 2.
Air dispersion calculations. 3.
Potential for fire. 4.
Physical, chemical, toxicological, and other characteristics of substances present. 5.
Physical and topographical features of the site. 6.
Weather conditions, particularly the direction of prevailing winds relative to the locations of the support zone and
other uncontaminated areas onsite.
7.
Potential for explosion and flying debris. 8.
Check in and out of this zone at the designated access point(s). 1.
Use the buddy system at all times. 2.
Wear the PPE required for this zone (see PPE section of this HASP). 3.
Perform air monitoring as required for this zone (see Exposure Monitoring section of this HASP). 4.
No smoking, eating, or drinking. 5.
No matches, lighters, or open flame. 6.
Monitor self and buddy for signs of heat or cold stress or chemical overexposure. 7.
Alert supervisor to signs of changing or unanticipated hazards. 8.
No horseplay. 9.
Monitor self and buddy for PPE rips, tears, and/or damage. 10.
Use monitoring equipment and tools that are safe for the working environment. 11.
Use ground-fault circuit interrupters (GFCIs) when necessary to prevent electric shock. 12.
Use three-wire grounded extension cords for portable electric tools and appliances. 13.
Keep loose-fitting clothing or loose long hair away from moving machinery. 14.
Use signaling to direct heavy equipment operating in tight quarters. 15.
No refueling engines while equipment is running. 16.
No ignition sources within 50 feet of refueling areas. 17.
Lower all blades and buckets to the ground and set parking brakes before shutting off vehicles. 18.
Never exceed the rated load capacity of a vehicle. 19.
3 - 2 of 6 Date of Program : Site Name :Former Texaco Food Mart #
Workers and equipment exit the Exclusion Zone through the designated access point(s) into the CRZ. Workers and equipment are
then decontaminated in the CRZ, according to the procedures specified in the Decontamination section of this HASP. Workers and
equipment then exit the CRZ into the Support Zone through the designated access points, shown in Figure 3-1.
Within the Support Zone, personnel will adhere to the following SOPs:
3.5 Buddy System
While working in the Exclusion Zone, site workers use the buddy system. The buddy system means that personnel work in pairs
and stay in close visual contact to be able to observe one another and summon rapid assistance in case of an emergency. The
responsibilities of workers using the buddy system include:
If necessary, emergency decontamination procedures are implemented. Emergency decontamination procedures are described in
the site's emergency response program.
Personnel in the CRZ will adhere to the following SOPs:
The Support Zone is the clean area of the site, beyond the outer boundary of the CRZ. There should be no contamination in this
zone. Administrative, clerical, and other support functions are based in the Support Zone.
Support Zone
The Support Zone is shown in Figure 3-1 and its boundaries are marked by CATLIN personnel determines boundaries when on-
site..
3.6 Site Communications
The following communication equipment is used to support on-site communications:
Telephones at this site are located in the following areas:
Contamination Reduction Zone (CRZ) SOPs
Support Zone (SZ) SOPs
Based on monitoring results, the CRZ boundaries may be adjusted to ensure that the Support Zone remains uncontaminated.
Air and surface monitoring are conducted in the Support Zone as needed to ensure that it remains uncontaminated. If
contamination is detected, zone boundaries are adjusted until corrective action is taken and monitoring results indicate that this
zone is again uncontaminated.
* remaining in close visual contact with partner,
* providing partner with assistance as needed or requested,
* observing partner for signs of heat stress or other difficulties,
* periodically checking the integrity of partner's PPE, and
* notifying the site manager or other site personnel if emergency assistance is needed.
Check in and out of this zone at the designated access point(s). 1.
Wear the PPE required for this zone (see PPE section of this HASP). 2.
Perform air and surface sampling as required for this zone (see Exposure Monitoring section of this HASP). 3.
Use monitoring equipment and tools that are safe for the working environment. 4.
No smoking, eating, or drinking. 5.
No matches, lighters, or open flame. 6.
Monitor self and buddy for signs of heat or cold stress or chemical overexposure. 7.
Alert supervisor to signs of changing or unanticipated hazards. 8.
No horseplay. 9.
Monitor self and buddy for PPE rips, tears, and/or damage. 10.
Check in and out of this zone at the designated site access point(s). 1.
Alert supervisor to signs of changing or unanticipated hazards. 2.
No horseplay. 3.
Perform air and surface sampling as required for this zone (see Exposure Monitoring section of this HASP). 4.
3 - 3 of 6 Date of Program : Site Name :Former Texaco Food Mart #
In addition, site personnel are trained to recognize and use hand signals when visual contact is possible but noise or PPE inhibit
voice communication. These hand signals are listed below in Table 3-6
Signal Meaning
Telephones at this site are located in the following areas:
A current list of emergency contact numbers is posted in the following locations:
Table 3-6 Site Communication - Hand Signals
Each person is equipped with a cell phone
Site Field Book
Clutching throat Out of air/cannot breathe
Thumbs down No
Thumbs up OK/understood
Both arms waving upright above head Need assistance/send support
Stand with hands on waist or grab partner's wrist Exit immediately
3 - 4 of 6 Date of Program : Site Name :Former Texaco Food Mart #
3.7 Emergency Medical Assistance (To be filled in by PM prior to start of any work)
The nearest emergency medical assistance selected to support this site is:
Organization:
Contact:
Address/Location:
Telephone:
Wake Forest Baptist Health
On-site Staff
Medical Center Blvd, Winston-Salem, NC 27157
3367169253
A map to this facility is located in the Emergency Response chapter of this HASP, Figure 11-3b.
3 - 5 of 6 Date of Program : Site Name :Former Texaco Food Mart #
Figure 3-1 Map of Site Boundaries, Work Zones, and Entry/Exit Points
Insert site map with zone boundaries and access points here.
3 - 6 of 6 Date of Program : Site Name :Former Texaco Food Mart #
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FIGUREPROJECTTITLE
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4.0 TRAINING PROGRAM
(in compliance with 29 CFR 1910.120(e))
4.1a Training Elements to be Covered for Site Workers:
* training for site workers
* site briefings for visitors and workers
* initial HAZWOPER training (40 or 24 hr)
* supervised field experience
* management and supervisor training
* qualification of trainers
* training certification
* emergency response training ##
* refresher training
* equivalent training
* training records
Other training received by workers that is in addition to required training elements described above is detailed below in
the following table (Table 4-1a):
Table 4-1a Other Training for Site Workers
The site training program is designed to ensure that workers receive the training they need to work safely on this site.
Site safety and health training requirements are based on the job hazard assessments contained in Chapter 2 of this
HASP and relevant OSHA requirements. At this site, CATLIN Project Manager oversees the implementation of this
training program and is responsible for ensuring that employees are adequately and currently trained for all tasks they are
asked to perform. Employees who have not been trained to a level required by their job function and responsibility are not
permitted to participate in or supervise field activities.
A site-specific briefing is provided to all site visitors who enter this site beyond the site entry point.
4.2 Initial Training
For visitors, the site-specific briefing provides information about site hazards, the site lay-out including work zones and
places of refuge, the emergency alarm system and emergency evacuation procedures, and other pertinent safety and
health requirements as appropriate.
This training program is consistent with the requirements of 29 CFR 1910.120(e) and addresses the following site-specific
information:
## Emergency response training is addressed in HASP Chapter 11, Emergency Response Plan.
- names of personnel and alternates responsible for site safety and health
- safety, health and other hazards present on the site
- use of PPE
- work practices by which the employee can minimize risks from hazards
- safe use of engineering controls and equipment on the site
- medical surveillance requirements detailed in Chapter 5 of this HASP
- decontamination procedures detailed in Chapter 10 of this HASP
- the emergency response plan detailed in Chapter 11 of this HASP
- confined space entry procedures detailed in Chapter 13 of this HASP
- the spill containment program detailed in Chapter 9 of this HASP
- the site control plan detailed in Chapter 3 of this HASP
4.1b Site-Specific Briefings for Visitors
Site personnel review this HASP and are provided a site-specific briefing prior to the commencement of work to ensure that
employees are familiar with this HASP and the information and requirements it contains. Additional briefings are provided as
necessary to notify employees of any changes to this HASP as a result of information gathered during ongoing site
characterization and analysis. Conditions for which we schedule additional briefings include, but are not limited to: changes in
site conditions, changes in the work schedule/plan, newly discovered hazards, and incidents occurring during site work.
4.1c HASP Information and Site-Specific Briefings for Workers
Heat and cold stress prevention
Working safely around heavy equipment
Hearing conservation, in accordance with 29 CFR 1910.95
Basic First Aid and CPR
4 - 1 of 2 Date of Program:Site Name:Former Texaco Food Mart
Personnel at this site must successfully complete 40-hour initial HAZWOPER training consistent with the requirements of 29
CFR 1910.120(e)(3)(i) in order to work in contaminated areas. In addition, such personnel provide documentation of having
received 3 days of supervised field experience applicable to this site, or receive three days of supervised field experience at this
site.
Training received by managers and supervisors is summarized below in the following table (Table 4-3):
Only instructors qualified in accordance with 29 CFR 1910.120(e)(5) are used to train workers for this site. Qualified
instructors have either completed a training program for teaching the subjects they are expected to teach or have the
academic credentials and instructional experience necessary for teaching the subjects.
Initial training requirements are based on a worker’s potential for exposure and compliance with the requirements of 29
CFR 1910.120(e)(3).
This site does not accept prior academic training or job site experience in lieu of HAZWOPER initial training for workers
and supervisors.
4.3 Management and Supervisor Training
On-site managers and supervisors who are directly responsible for or who supervise workers engaged in hazardous
waste operations receive, in addition to the appropriate level of worker HAZWOPER training described above, 8
additional hours of specialized supervisory training, in compliance with 29 CFR 1910.120(e)(4).
Table 4-3 Training for Managers and Supervisors
4.4 Qualification of Trainers
Employees and supervisors that receive and complete the necessary training and field experience are certified when
they complete the necessary training. A written certificate is given to each person so certified. Any person who has not
been so certified or who does not meet the requirements of equivalent training is prohibited from engaging in hazardous
waste operations on this site.
4.5 Training Certification
Emergency response training is addressed in Chapter 11 of this HASP, Emergency Response Plan.
4.6 Emergency Response
All workers on this site including managers and supervisors receive annual HAZWOPER refresher training consistent
with the requirements of 29 CFR 1910.120(e)(8). The following table (Table 4-7) details refresher training topics:
4.7 Refresher Training
Table 4-7 Refresher Training Topics
4.8 Equivalent Training
4.9 Training Records
This site maintains written certification of the successful completion of applicable training requirements for each worker.
Training records are maintained up-to-date and are retained onsite at the following location: CATLIN Wilmington Office.
Written certificates have been given to each person so certified. Additionally, an employee sign off sheet indicating that
each worker has received a copy of this HASP and understands its contents is stored at the same location.
Personal protective equipment program
Management of the site work zones
Employer’s safety and health program
Review of PPE including levels of protection
Review of safety procedures
Review of policy changes
Review of emergency response procedures
Review of physical hazards
Review of chemical hazards
4 - 2 of 2 Date of Program:Site Name:Former Texaco Food Mart
Medical Surveillance RequirementsLocationPeriodic ExamTask/OperationBaseline Exam
5.0 MEDICAL SURVEILLANCE
(in compliance with 29 CFR 1910.120(f) and other substance-specific medical surveillance requirements found in
29 CFR 1910.1001-1052)
5.1 Site Medical Surveillance Program
Medical surveillance requirements are based on a worker’s potential for exposure as determined by the site characterization and
job hazard analysis documented in Chapter 2 of this HASP and on compliance with the requirements of 29 CFR 1910.120(f)(2).
The medical surveillance program is consistent with 29 CFR 1910.120(f) and addresses the following information:
* provisions of the site medical surveillance program
* communication between the site, physicians, and workers
* medical recordkeeping procedures
The medical surveillance section of the Health and Safety Plan describes how worker health status is monitored at this site.
Medical surveillance is used when there is the potential for worker exposure to hazardous substance at levels above OSHA
permissible exposure limits or other published limits. The purpose of a medical surveillance program is to medically monitor
worker health to ensure that personnel are not adversely affected by site hazards. The provisions for medical surveillance at
this site are based on the site characterization and job hazard analysis found in Chapter 2 of this HASP and are consistent
with OSHA requirements in 29 CFR 1910.120(f) and the following substance-specific requirements: BENZENE (1910.1028,
1926.1128).
3. Medical examination for personnel within the medical surveillance program were determined by the site's attending
physician and include the following:
5.2 Communication Between the Site, Physicians, and Workers
The medical facility providing medical monitoring and overexposure examinations required by personnel at this site is:
The licensed attending physician for this site is:
CATLIN has provided information about site hazards and potential exposure levels, work activities, and PPE
requirements, and other information as required by OSHA in 29 CFR 1910.120(f)(6) to the above-mentioned facility and
physician. CATLIN will also make this information available to site personnel and/or their personal physicians.
A physician’s written opinion of the results of these examinations is required for each worker and a copy is maintained at
CATLIN's Corporate Office. The contents of the written opinion is limited to:
* a statement of the worker’s health status in relation to his or her job duties and a description of any detected medical
condition that could put the worker at increased risk.
* notation of any recommended limitations in work activity or PPE use.
* confirmation that the physician has informed the employee of the examination results and any further examination or
treatment required.
Name:
Location:
Phone:
Name:
Phone:
The person with responsibility for ensuring this program is implemented and maintained is Mike D. Mason.
Operational Phase
Medac Coporate Health
4402 Shipyard Blv. Wilmington, NC
9104527000
Dan Shapiro, PA-C
9104527000
Table 5-1a Types of Workers Included in the Medical Surveillance Program
Termination Exam
Table 5-1b Medical Surviellance for Site Workers
Monitoring Gauge and Sample
Wells
Subject Site
Survey Receptor Survey within 1,500
feet of the site
5 - 1 of 2 Date of Program:Site Name:Former Texaco Food Mart
5.3 Medical Recordkeeping Procedures
(in compliance with 29 CFR 1910.120(f)(8) and 1910.1020)
The following items are maintained in worker medical records:
5.4 Program Review
* review of accident and injury records and medical records to determine whether the causes of accidents and illness
are promptly investigated and whether corrective measures are taken wherever possible,
* evaluation of the appropriateness of required medical tests on the basis of site exposures, and
* review of emergency treatment procedures and emergency contacts list to ensure they are site-specific, effective,
and current.
Corporate medical recordkeeping procedures are consistent with the requirements of 29 CFR 1910.1020 and
are described in the company’s overall safety and health program. A copy of that program is available at
CATLIN Corporate Office.
Every year, the medical program is reviewed to ensure its effectiveness. Dan Shapiro, PA-C is responsible for this
review. At a minimum, this review consists of:
Records required under this medical surveillance program, consistent with 1910.120(f)(8), are kept accurate
and updated and are available on site at Admin Office.
Respirator fit test and selection
Physician's medical opinion of fitness for duty (pre-placement, periodic, termination)
Physician's medical opinion of fitness for respirator protection (pre-placement, periodicc)
Exposure monitoring results
5 - 2 of 2 Date of Program:Site Name:Former Texaco Food Mart
6.0 PERSONAL PROTECTIVE EQUIPMENT
(in compliance with 29 CFR 1910.120(b)(4)(ii)(C) and 29 CFR 1910.120(g))
This chapter of the HASP describes how personal protective equipment (PPE) is used to protect against employee
exposures to hazardous substances and hazardous conditions on this site. Exposure hazards from the decontamination
process are also considered. The following topics are addressed in this chapter:
6.1 PPE Selection Criteria
Site safety and health hazards are eliminated or reduced to the greatest extent possible through engineering controls and
work practices. Where hazards are still present, a combination of engineering controls, work practices, and PPE are used
to protect employees.
* PPE selection criteria
* Site-specific PPE ensembles
* Criteria for PPE upgrades and downgrades
* Procedures for determining work duration
The person with the overall responsibility for the PPE program is CATLIN Project Manager.
An initial level of PPE is assigned to each task to provide an adequate barrier to exposure hazards. Initial PPE ensembles
are selected based on the anticipated route(s) of entry of the hazardous substances on site and their concentration.
Ensemble materials are selected using permeation data supplied by individual manufacturers. Materials providing the
greatest duration of protection have been chosen. Tear and seam strength of the PPE are also considered to ensure
ensemble durability while work is performed. When necessary, multiple layers of protection are used to accommodate
the range of hazards that may be encountered. Where possible, employees are provided with a range of component sizes
to ensure properly fitted PPE.
* Training in use of PPE
* Respiratory protection
* Hearing conservation
* PPE maintenance & storage
* Evaluation of this program
The following criteria are used in selecting PPE levels at this site.
Use of Level D Protection
Employees use Level D protection during tasks that have the following characteristics:
* The atmosphere contains no known or suspected hazardous substances at concentrations that meet or exceed the published
exposure limit.
* Contact with hazardous levels of any chemicals through splashes, immersion, or by other means will not occur.
* There is no potential for unexpected inhalation or contact with hazardous levels of any chemical.
6 - 1 of 5 Date of Program:Site Name:Former Texaco Food Mart
6.2 Use of PPE
Site-specific PPE ensembles and materials are identified below in Table 6-2a. These ensembles are consistent with
Appendix B of 29 CFR 1910.120. PPE is used in accordance with manufacturers’ recommendations.
6 - 2 of 5 Date of Program:Site Name:Former Texaco Food Mart
Coveralls/Standard Work Clothes
Company Supplied No
Company Supplied No
Level D
Boots/shoes, chemical-resistant steel toe and
shank
Escape Mask: N/A
Table 6-2a Site-Specific PPE Ensembles
Equipment Model Material Employee
Purchased
Safety glasses Company Supplied Plastic No
Hard hat Company Supplied Plastic No
Gloves Company Supplied Leather and other No
6 - 3 of 5 Date of Program:Site Name:Former Texaco Food Mart
Criteria for PPE Upgrades and Downgrades
Task-specific criteria for PPE upgrades and downgrades are used at this site. If the need for a PPE upgrade or
downgrade is anticipated for a task or operation, the action level(s) and/or conditions that result in a PPE upgrade or
downgrade are described on the Job Hazard Analysis form (JHA) in Chapter 2 of this HASP. Since PPE is primarily used
as a barrier to hazardous substance exposure, airborne concentrations are monitored routinely, in accordance with
Chapter 7, Exposure Monitoring.
TBD has the authority to upgrade or downgrade PPE in a timely manner to respond to changing site conditions and to protect
employee health and safety. Routine evaluation of the effectiveness of the PPE program is conducted as identified in Section
6.7 below.
Procedures for Determining Work Duration
SSHO identifies task-specific work duration based on the following:
Employees are informed about task-specific work duration by the SSHO, during pre-entry briefing for each task
Work duration is consistent with the requirements outlined in Chapter 8, Thermal Stress and the respiratory protection capacity
for the assigned PPE. Work duration is continuously re-evaluated in response to changes in working conditions.
6.3 Training
Employees receive general training regarding proper selection, use and inspection of PPE during initial HAZWOPER training (or
equivalent) and subsequent refresher training. Site-specific PPE requirements, including task-specific PPE, ensemble
components, cartridge/canister service times, and inspection and maintenance procedures are communicated as identified in
Chapter 4, Training.
6.4 Respiratory Protection
The type of respiratory protection used on site are identified in Table 6-2a. Respiratory protection is selected, fitted, used,
stored and maintained in accordance with CATLIN's Respiratory Protection Program. A copy of the Respiratory Protection
Program is included in Section 12. The written Respiratory Protection Program is consistent with the other requirements of this
HASP.
6.5 Hearing Conservation
Employees must use hearing protection when noise exposures equal or exceed an 8-hour time-weighted average sound level of
85 dBA. Where noise exposure meets or exceeds this level, noise is listed as a physical hazard in the JHA for the
tasks/operation, and hearing protection is included as one of the control measures (PPE). Employees required to use hearing
protection participate in a Hearing Conservation Program. A copy of CATLIN's Hearing Protection Program is included in
Section 12.Currently, no site tasks have noise exposure that equals or exceeds the 85 dBA limit.
6.6 PPE Maintenance Storage
In order to ensure that PPE continues to provide the anticipated protection, this site uses specific procedures for PPE
inspection, cleaning, maintenance, and storage. Adherence to these procedures is tracked with written inspection records.
6.7 Evaluation of PPE Program
Evaluation of the effectiveness of site PPE selections occurs throughout site activities in response to employee exposure
monitoring results and employee feedback. Surface samples are collected from the inside surfaces of used PPE to ensure that
the equipment provides an adequate barrier throughout the work shift. Surface monitoring procedures are described in Chapter
7 of this HASP, Exposure Monitoring.
Mike D. Mason is responsible for modifying initially selected PPE. Affected employees are immediately informed about these
modifications and are provided with additional training if necessary. The JHAs in Chapter 2 of the HASP are also updated as
needed to reflect current information about job hazards and selected controls.
* Physiological requirements of the task
* PPE level for the task
* Ambient temperature and humidity
* Respiratory protection capacity (air supply or cartridge change requirements)
* Chemical protective clothing capacity (permeation rate of on-site materials)
* Acclimatization of the work force
6 - 4 of 5 Date of Program:Site Name:Former Texaco Food Mart
6 - 5 of 5 Date of Program:Site Name:Former Texaco Food Mart
7.0 EXPOSURE MONITORING
(in compliance with 29 CFR 1910.120(b)(4)(ii)(E) and 29 CFR 1910.120(h))
This chapter of the HASP describes how employee exposures to hazardous substances are monitored. This chapter
provides site-specific information about:
7.1 Air Monitoring
Employee exposures to airborne hazardous substances are fully characterized throughout site operations to ensure that
exposure controls are effectively chosen and modified as needed on a timely basis. The approach to air monitoring is
consistent with OSHA requirements in HAZWOPER and includes:
* air monitoring procedures,
* surface sampling procedures,
* equipment calibration and maintenance, and
* the handling and management of monitoring data.
SSHO is responsible for implementing site exposure monitoring procedures.
* initial monitoring prior to the beginning of site activities to identify conditions that may cause death or serious harm and
to permit preliminary selection of site controls,
The following personnel are qualified to use the air monitoring instruments at this site and to interpret monitoring
results:
The following personnel are qualified to conduct surface sampling at this site and to interpret surface sampling results:
Sean O'Neil
Ben Ashba
Bill Miller
Bill Walsh
Robert Baldwin
Corey Futral
Jason Catlin
Stacey Martin
Nate Newman
Matthew Aupperle
Trevor Mizelle
Abby Wesley
* personal monitoring after site activities begin so that employee exposures are quantified and fully characterized, and
Monitoring Instrument
Abby Wesley
Ben Ashba
Bill Miller
Bill Walsh
Corey Futral
Jason Catlin
Matthew Aupperle
Nate Newman
Robert Baldwin
Sean O'Neil
Stacey Martin
Trevor Mizelle
7 - 1 of 3 Date of Program:Site Name:Former Texaco Food Mart
7.2 Surface Sampling
-commencement of work on another portion of the site,
Air monitoring is conducted using direct-reading instruments and by collecting and analyzing personal samples. Consistent with
HAZWOPER, personal air samples are collected in the breathing zones of employees expected to have the highest exposure
during the task or operation being evaluated. If exposures for these employees exceed the exposure limits, additional samples
are collected in the breathing zones of all employees likely to have similar exposures. Full-shift and short-term samples are
collected, providing quantitative results that can be compared to OSHA Permissible Exposure Limits and other published
exposure limits. In addition, the results of lab-analyzed samples are correlated with direct-reading monitoring results to ensure
that direct-reading results are interpreted correctly.
If an employees exposure to Benzene or Lead exceed Permissible Exposure LImits established by OSHA, then the employee(s)
shall be notified in writing within 15 working days of receipt of air monitoring results. The employer shall provide air monitoring,
engineering controls, etc. in accordance with 29 CFR 1910.1025 for Lead and 29 CFR 1910.1028 for Benzene if the potential
exposure exists.
Surface sampling is used as needed in contaminated areas to evaluate potential employee exposures. Surface sampling is
used in the CRZ and SZ to evaluate the effectiveness of decontamination methods and exposure controls, including hygiene
practices, and to ensure that zone boundaries accurately reflect the presence or absence of contamination. Surface sample
locations, methods, and permissible contamination limits are listed in Table 7-2.
Table 7-1, Task-Specific Air Monitoring Procedures, summarizes the air monitoring procedures for this site based on tasks and
operations conducted here. This table includes action levels and required actions we have established based on the direct-
reading instruments we use and the contaminants we measure.
* periodic monitoring throughout site operations when conditions and employee exposures may change rapidly. This can
include, but is not limited to, the following situations
-exposure to or handling of contaminants/hazards not previously identified,
-commencement of a new task/operation,
-change in environmental conditions, and
-commencement of task/operation that is likely to increase airborne concentrations of hazardous substances.
This site contains contaminants addressed in one or more of OSHA's substance-specific standards, specifically
BENZENE; ETHYL BENZENE; METHYL TERT-BUTYL ETHER; NAPHTHALENE; TOLUENE; XYLENE, ALL ISOMERS.
Site monitoring procedures comply with OSHA's substance-specific requirements as well as those of HAZWOPER.
Table 7-1: Task-Specific Air Monitoring Procedures
7.3 Equipment Calibration and Maintenance
Surface concentrations in excess of the established limits may result in adjustments of PPE, decontamination procedures, site
zone boundaries, and other exposure controls. Mike D. Mason is responsible for evaluating surface sampling results and
determining corrective actions if sample results indicate contaminant levels in excess of permissible surface concentration.
Table 7-2 Surface Monitoring Procedures
Table 7-3 Equipment Calibration Maintenance
7.4 Handling and Maintenance of Monitoring Data
7 - 2 of 3 Date of Program:Site Name:Former Texaco Food Mart
Laboratory results are available within 10 days of sample collection. Employees may review general air and surface monitoring
results and may obtain copies of their personal monitoring results. Results from lab-analyzed samples are stored on site in/at:
Cooler. Direct-reading monitoring results are documented and stored in/at: Field Book.
Employees who participated in an air monitoring event receive written notification of their respective personal exposures within
1 working days of receipt of results. Mike D. Mason is responsible for providing employees with copies of their exposure
monitoring results and helping them understand the information.
7.5 Noise Monitoring
Procedures for collecting, handling, and shipping laboratory samples are included Chapter 12, Standard Operating Practices
and in the sampling methods identified in Table 7-1. Documentation procedures for analytical results and direct-reading
monitoring data are also addressed in Chapter 12. Samples are shipped to and analyzed by the laboratory selected by the PM.
Currently, no site tasks have noise exposure that equals or exceeds the 85 dBA limit so noise monitoring is not conducted.
Laboratory Name: Con-Test Analytical Laboratory
Addresses: 6104 Westgate Road, Suite 129
Raleigh NC, 27617
Telephone: [phone]
Laboratory Contact: Adam Phillips
All analytes
Analyte(s)
7 - 3 of 3 Date of Program:Site Name:Former Texaco Food Mart
8.0 THERMAL STRESS PREVENTION PROGRAM
(in compliance with 29 CFR 1910.120(h))
8.1 Implementation Criteria
This section of the HASP describes how the site-specific environmental conditions (temperature, humidity, air movement), work
loads, and PPE may expose workers to hazards resulting in illness or injury related to heat or cold stress. This Thermal Stress
Prevention Program outlines exposure controls designed to protect workers working in hot or cold environments. The elements
of this program are outlined in this section and include the following:
* Implementation criteria
* Prevention strategies
* Medical management
* Employee training
SSHO is responsible for implementing this program.
The Thermal Stress Prevention Program is implemented when the work area temperature rises above 95 oF WBGT or falls
below 35 oF Wind Chill Adjusted.
Throughout each work shift, air temperatures in the work area are measured, the adjusted temperature is calculated, and
the values are recorded Cell Phones.
8.2 Prevention Strategies
Heat Stress
· defining and adjusting worker work/rest intervals
· monitoring for signs of heat stress
· providing shaded rest areas protected from radiant heat
· using a liquid replacement program
· providing cooling garments or other PPE
Work practices and exposure controls are used to reduce the risk of elevating a worker’s core body temperature.
These work practices and exposure controls include the following:
Work Area Temperature Range PPE Level
Worker Work/Rest Intervals
Table 8-2hb: Heat Stress Work/Rest Schedules
Work/rest intervals are based on PPE, work loads, environmental conditions (temperature, humidity, air movement),
and monitoring results. Work/rest intervals are determined by All Site Workers. Work/rest intervals are adjusted
throughout the work shift as needed and communicated to each worker at the conclusion of an applicable rest period,
prior to reentry into the work zone. Guidelines for work/rest schedules for this site are provided in Table 8-2hb.
Work Period (minutes)Rest Period (minutes)
>95 Level D 30 minutes 5 minutes
Monitoring
We also use physiological monitoring to alert workers and their supervisors to potential heat stress illness.
Physiological monitoring is conducted by the employees themselves. The schedule and approach to physiological
monitoring at this site is described in Table 8-2hc.
Workers monitor each other’s actions, speech, and appearance for signs and symptoms of heat-related illnesses
including heat exhaustion and heat stroke. Physical signs and symptoms of heat exhaustion include headache,
nausea, vertigo, weakness, thirst, and giddiness. Heat exhaustion may progress to heat stroke if a worker is unable
to cool and re-hydrate their body. The primary signs and symptoms of heat stroke are confusion; irrational behavior;
loss of consciousness; convulsions; a lack of sweating (usually); hot, dry skin; and an abnormally high body
temperature. Workers should be aware of the key differences between the signs and symptoms of heat stroke and
those of heat exhaustion, such as the lack of sweating, the color of the skin (red), and the rise in body temperature.
Heat stroke is a medical emergency that requires immediate medical attention.
Physical signs and symptoms of heat stress are discussed with workers Daily and reviewed as necessary.
8 - 1 of 4 Date of Program:Site Name:Former Texaco Food Mart #
Type of monitoring Monitoring Location
Table 8-2hc Heat Stress Physiological Monitoring Procedures
Monitoring
Frequency
Action Level Required Action
Heart rate (pulse)on-site when needed
Visual on-site Before and after each
work period
Rest Areas
Rest areas that are shaded and protected from radiant heat are located:
company vehicles
Rest areas are equipped with cool (50?- 60?F) liquids.
Work Area Temperature
Range
Work Period Between
Drinks
Liquid Replacement Program
Table 8-2hd Heat Stress Liquid Replacement Regimen
Minimum Quantity
(Ounces)
Liquid Type
Since dehydration is a primary cause of heat illness, workers on this site follow a regimen for liquid consumption
detailed in Table 8-2hd.
>95 30 minutes 1 cup (8 oz.)Water
>95 30 minutes 1 cup (8 oz.)Sports drink
Work Area Temperature Range Task/Location
Use of Cooling Garments:
Table 8-2hf: Use of Cooling Garments
PPE Level Cooling Garment Used
Cooling garments are provided for workers to reduce the risk of heat related illnesses and injuries. Workers don the
appropriate cooling garment based on the guidelines provided in Table 8-2hf.
>95 Receptor Survey -- within
1,500 feet of the site
Level D Air circulation
>95 Gauge and Sample Wells --
Subject Site
Level D Air circulation
Cold Stress
· defining and adjusting worker work/rest intervals
· monitoring for physiological signs of cold stress
· providing warm, sheltered rest areas
· providing warm liquids
· providing and requiring the use of warm garment or other PPE
Work practices and exposure controls are used to reduce the risk of lowering a worker’s core body temperature.
These work practices and exposure controls include the following:
Worker Work/Rest Intervals
Work/rest intervals are based on PPE, work load, environmental conditions, and monitoring results.
Work/rest intervals are determined by All Site Workers and communicated to workers. Work/rest
intervals are adjusted throughout the work shift as needed and communicated to each worker at the
conclusion of an applicable rest period, prior to reentry into the work zone. Guidelines for work/rest
schedules for this site are provided in Table 8-2ca. Resting workers are sheltered in a warm
enclosure.
8 - 2 of 4 Date of Program:Site Name:Former Texaco Food Mart #
8.3 Medical Management
If a worker exhibits signs or symptoms of heat exhaustion or heat stroke, we use the following procedures:
* site person in shade
* cool wrap on head
* get liquids in person
* get person ice
* contact 911 if needed
The physician's written opinion specifically addresses fitness for duty for under heat stress conditions. This evaluation is
described in Chapter 5, Medical Surveillance.
8.4 Training
Work Area Temperature Range PPE Level
Table 8-2ca: Cold Stress Work/Rest Schedules
Work Period (minutes)Rest Period (minutes)
<35 Level D 30 minutes 5 minutes
Monitoring
Workers monitor each other’s actions, speech, and appearance for signs and symptoms of cold-
related injury including hypothermia and frostbite. The first symptoms of hypothermia are
uncontrollable shivering and the sensation of cold. Cool skin, muscle rigidity, low blood pressure,
slowed or irregular pulse and apparent exhaustion and fatigue after rest manifest as hypothermia
progresses and the core body temperature falls. Frostbite can occur without hypothermia when
extremities do not receive sufficient heat from central body stores. Frostbite occurs when the fluids
around the tissue cells freeze and usually affects the extremities, nose, and cheeks. Damage from
frostbite can result in tissue death.
Physical signs and symptoms of hypothermia and frost bite are discussed with workers Daily and
reviewed as necessary.
Warm Shelters
Warm, non-caffeinated liquids are provided in each rest area.
Worker rest areas are warm and isolated from environmental conditions. These rest areas are located at vehicles.
Work Area
Temperature Range
Work Period
Between Drinks
Liquid Replacement Program:
Table 8-2cb Cold Stress Liquid Replacement Regimen
Minimum Quantity
(Ounces)
Liquid Type
Dehydration through perspiration is a concern in cold weather. Workers on this site follow the liquid
replacement regimen in Table 8-2cb.
<35 30 minutes 1 cup (8 oz.)Water
Work Area Temperature Range Task/Location
Use of Cold Temperature Clothing:
Table 8-2cc Use of Cold Temperature Clothing
PPE Level Cold Temperature Clothin
Workers don layered thermal protective clothing based on the guidelines provided in Table 8-2cc.
<35 Receptor Survey -- within
1,500 feet of the site
Level D Insulated clothing
<35 Gauge and Sample Wells --
Subject Site
Level D Insulated clothing
Physical signs and symptoms of heat stress are discussed with workers <35 and reviewed as
necessary.
8 - 3 of 4 Date of Program:Site Name:Former Texaco Food Mart #
Workers receive general training regarding thermal stress-related injuries and illnesses during initial HAZWOPER training and
subsequent refresher training. The site-specific program and procedures are described in Chapter 4, Training.
8 - 4 of 4 Date of Program:Site Name:Former Texaco Food Mart #
9.0 SPILL CONTAINMENT PROGRAM
(in compliance with 29 CFR 1910.120(b)(4)(ii)(J) and (j)(1)(viii))
This chapter of the Health and Safety Plan describes the potential for hazardous substance spills at this site and
procedures for controlling and containing such spills. The purpose of this chapter of the Plan is to ensure that spill
containment planning is conducted and appropriate control measures are established.
The spill containment program is consistent with OSHA requirements in 29 CFR 1910.120(b)(4)(ii)(J) and (j)(1)(viii) and
addresses the following site-specific information:
* potential hazardous substance spills and available controls
* initial notification and response
* spill evaluation and response
* post-spill evaluation
9.1 Potential Spills and Available Controls
Table 9-1 below lists the location and type of potential hazardous substance spills at this site. This table also describes the
activities or situations in which an accidental spill could occur and the type of release--either an incidental or an emergency
release -- likely to result.
Wherever spills, leaks, or ruptures can occur, this site keeps suitable quantities of proper absorbent and US Department of
Transportation-specified salvage drums/containers. Their location is noted in Table 9-1. In addition, all areas subject to
potential spills are diked or a means to adequately dike these areas in the event of a spill is available so that the entire
volume of the hazardous substance being spilled can be contained and isolated. The type and location of spill
containment equipment is also listed in Table 9-1.
Table 9-1 Potential Spills and Controls
9.2 Initial Spill Notification and Response
9.3 Spill Evaluation and Response
Any worker who discovers a hazardous substance spill will immediately notify (name/title). The worker will, to his/her best ability,
report the hazardous substance involved, the location of the spill, the estimated quantity of material spilled, the direction/flow of
the spill material, related fire/explosion incidents, and any associated injuries. The site Emergency Response Plan, found in
Chapter 11 of this HASP, will immediately be implemented if an emergency release has occurred.
(Name/title) is responsible for evaluating spills and determining the appropriate response. When this evaluation is being made,
the spill area will be isolated and demarcated to the extent possible.
Table 9-3 Off-site Notification Requirements
Location
Spill Volume/
Conditions Required Notification
The procedures of the Emergency Response Chapter of this HASP are implemented when the spill is determined to
require emergency precautions and action. If necessary to protect nearby community members, notification of the
appropriate authorities is made. Table 9-3 below lists the spill conditions that trigger notification of Federal, state, and
local agencies.
When an incidental release occurs, cleanup personnel receive instructions in a pre-cleanup meeting as to spill conditions,
PPE, response activities, decontamination, and waste handling. The following are general measures that response/
cleanup personnel take when responding to a spill:
Hazardous Substance
* To minimize the potential for a hazardous spill, hazardous substance and contaminated soils, control/absorbent
media, drums and containers, and other contaminated materials are properly stored and labeled.
9 - 1 of 2 Date of Program:Site Name:Former Texaco Food Mart #
9.4 Post-Spill Evaluation
A written spill response report is prepared at the conclusion of clean-up operations. The report includes, at a minimum,
the following information:
* date of spill incident
* cause of incident
* spill response actions
* any outside agencies involved, including their incident reports
* lessons learned or suggested improvements
The spill area is inspected to ensure the area has been satisfactorily cleaned. The use of soil, water, and air sampling is
utilized in this determination as necessary. The root cause of the spill is examined and corrective steps taken to ensure
the engineering and control measures in place have performed as required. If alternative precautions or measures are
needed, they are made available and implemented.
All durable equipment placed into use during cleanup activities is decontaminated as specified in the Decontamination
chapter of this HASP for future utilization. All spill response equipment and supplies are replenished as required.
* When a spill occurs, only those persons involved in overseeing or performing spill containment operations will be
allowed within the designated hazard areas. If necessary, the area will be roped, ribboned or otherwise blocked off.
Unauthorized personnel are kept clear of the spill area.
* Appropriate PPE, as specified during the pre-cleanup meeting, is donned before entering the spill area.
* Appropriate spill control measures are specified in the pre-cleanup meeting and applied during spill response.
* Whenever possible without endangerment of personnel, the spill is stopped at the source or as close to the source
as possible.
* Ignition points are removed if fire or explosion hazards exist.
* Surrounding reactive materials are removed.
* Drains or drainage in the spill area will be blocked or surrounded by berms to exclude the spilled waste and any
materials applied to it.
* Provisions are made to contain and recover a neutralizing solution, if used.
* Small spills or leaks from a drum, tank, or pipe will require evacuation of at least __ feet in all directions to allow
cleanup and to prevent employee exposure. For small spills, sorbent materials such as sand, sawdust, or
commercial sorbents (see Table 9-1 above for site-specific sorbent media) are placed directly on the waste to
prevent further spreading and aid in recovery.
* If any spill is large and/or continuing, an initial isolation area of at least __ feet in all directions is used. Large spills
are diked at the leading edge of the spill. Berms of earthen or sorbent material are constructed downstream of the
leading edge of the spill to contain it. Where feasible, pumps are utilized to transfer the liquid to appropriate
containers.
* Spill area is sprayed with appropriate foam where the possibility of volatile emissions exist.
* If the spill results in the formation of a toxic vapor cloud, from vaporization, or reaction with surrounding materials
or by the outbreak of fire, further evacuation may be required.
* To dispose of spill waste, all contaminated sorbents, liquid waste, or earthen material will be cleaned up and
placed in small quantities (__ pounds) in approved drums for proper storage or disposal as hazardous waste.
9 - 2 of 2 Date of Program:Site Name:Former Texaco Food Mart #
10.0 DECONTAMINATION
(in compliance with 29 CFR 1910.120(b)(4)(ii)(G) and 1910.120(k))
* the location and type of site decontamination facilities
* general and specific decontamination procedures for personnel and PPE
* general and specific decontamination procedures for equipment
On-site field personnel oversees implementation of site decontamination procedures and is responsible for ensuring their
effectiveness.
Based on the nature of the hazards and duration of work, showers and change rooms are not necessary and are not provided for
workers.
The decontamination section of the Health and Safety Plan describes how personnel and equipment are decontaminated when
they leave the Exclusion Zone. This section also describes how residual waste from decontamination processes is disposed.
The site decontamination procedures are designed to achieve an orderly, controlled removal or neutralization of contaminants
that may accumulate on personnel or equipment. These procedures minimize worker contact with contaminants and protect
against the transfer of contaminants to clean areas of the site and off-site. They also extend the useful life of PPE by reducing
the amount of time that contaminants contact and can permeate PPE surfaces. The decontamination procedures described
below are designed to meet the requirements of 1910.120(k) and include site-specific information about:
* disposal of residual waste from decontamination
* monitoring the effectiveness of decontamination procedures
* decontamination equipment and solvents
10.1 Site Decontamination Facilities
10.2 Decontamination Procedures for Personnel and PPE
Decontamination procedures on this site are designed for the level of PPE used. Site-specific procedures for personnel and PPE
decontamination minimize the potential for hazardous skin or inhalation exposure and to avoid cross-contamination and
chemical incompatibilities.
Decontamination on this site is conducted in the contamination reduction zone (CRZ). The CRZ acts as a buffer between the hot-
zone and the support zone. The location and design of decontamination stations minimize the spread of contamination beyond
these stations. Separate facilities are used for personnel and for equipment. The location of these facilities is marked on Figure
3-1.
The following are general decontamination procedures established and implemented at this site. More specific procedures for
personnel and PPE decontamination are provided in Table 10-2.
Emergency decontamination procedures are detailed in the Emergency Response section of this HASP.
Decontamination is required for all workers exiting a contaminated area. Personnel may re-enter the Support Zone
only after undergoing the decontamination procedures described below in the next section.
1.
Protective clothing is decontaminated, cleaned, laundered, maintained and/or replaced as needed to ensure its
effectiveness.
2.
PPE used at this site that requires maintenance or parts replacement is decontaminated prior to repairs or service. 3.
PPE used at this site is decontaminated or prepared for disposal on the premises. Personnel who handle
contaminated equipment have been trained in the proper means to do so to avoid hazardous exposure.
4.
This site uses an off-site laundry for decontamination of PPE. The site has informed that facility of the hazards
associated with contaminated PPE from this site.
5.
The site requires and trains workers that if their permeable clothing is splashed or becomes wetted with a
hazardous substance, they will immediately exit the work zone, perform applicable decontamination procedures,
shower, and change into uncontaminated clothing.
6.
Procedures for disposal of decontamination waste meet applicable local, State, and Federal regulations. 7.
10 - 1 of 3 Date of Program:Site Name:Former Texaco Food Mart
Tables 10-2a and -2b lists site-specific procedures for personnel decontamination and handling of personnel decontamination
waste.
Table 10-2a Level D Storage & Cleaning Procedures
Stored in vehicles prior to use
10.3 Decontamination Procedures for Equipment
All tools, equipment, and machinery from the Exclusion Zone or CRZ are decontaminated in the CRZ prior to removal to the
Support Zone. Equipment decontamination procedures are designed to minimize the potential for hazardous skin or inhalation
exposure and to avoid cross-contamination and chemical incompatibilities.
Level D Storage Procedures:
Throw away nitrile gloves, store safety glasses, saftey vests and hard hats in vehicle
Level D Cleaning Procedures:
Other Level D Special Handling Requirements:
General Equipment Decontamination Procedures:
Tables 10-3a and -3b lists site-specific procedures for equipment decontamination and handling of equipment decontamination
wastes.
Type of Equipment Decontamination
Solution
Decontamination
Procedure
The following are general equipment decontamination procedures established and implemented at this site. More specific
procedures for equipment decontamination are provided in Table 10-3a and 10-3b.
Table 10-3b Waste Handling for Equipment Decontamination
Table 10-3a Equipment Decontamination Procedures
Decontamination is required for all equipment exiting a contaminated area. Equipment may re-enter the Support
Zone only after undergoing the equipment decontamination procedures described in the table below (Table 10-3, Site-
specific Equipment Decontamination Procedures).
1.
Vehicles that travel regularly between the contaminated and clean areas of the site are carefully decontaminated
each time they exit the Exclusion Zone and the effectiveness of that decontamination is monitored to reduce the
likelihood that contamination will be spread to other parts of the site.
2.
Particular attention is given to decontaminating tires, scoops, and other parts of heavy equipment that are directly
exposed to contaminants and contaminated soil.
3.
Sampling equipment Tap water
Soap
Water or liquid rinse using pressurized or gravity flow
Water or liquid rinse using pressurized or gravity flow
Waste Streams/Products
for Equipment
Disposal Procedures for
Waste Stream/Product
Table 10-2b Waste Handling for Personnel Decontamination
disposable bailers throw away
nitrile gloves throw away
water level indicater decon on-site near well
Waste Streams/Products
for Equipment
Disposal Procedures for
Waste Stream/Product
water spread on-site
10 - 2 of 3 Date of Program:Site Name:Former Texaco Food Mart
10.4 Monitoring the Effectiveness of Decontamination Procedures
Visual examination and sampling are used to evaluated the effectiveness of decontamination procedures, in compliance with 29
CFR 1910.120(k)(2)(iv). Visual examination is used to ensure that procedures are implemented as described and that they
appear to control the spread of contaminants under changing site conditions. Visual examination is also used to inspect for
signs of residual contamination or for contaminant permeation of PPE.
Sampling, both air sampling and surface sampling, are used to verify the effectiveness of decontamination. Air samples are
taken in the clean zone to ensure that airborne contaminants have not spread to clean areas of the site. Surface samples are
taken from the inside surfaces of PPE, from decontaminated heavy equipment, and from surfaces within clean areas of the site to
ensure that site decontamination and control procedures are performing as anticipated. The type and frequency of air and
surface sampling used to ensure the effectiveness of decontamination procedures are detailed in the Exposure Monitoring section
of this HASP.
Personnel who work in contaminated areas of the site, either the Contamination Reduction Zone (CRZ) or the Exclusion Zone,
are trained in the principles and practices of decontamination described in this section of the HASP and in related SOPs. If site
procedures are changed as a results of inspection and monitoring, all affected employees are notified of these changes.
Results of the inspections of decontamination procedures and documentation of any action taken to correct deficiencies are
recorded and stored at Field Book .
10 - 3 of 3 Date of Program:Site Name:Former Texaco Food Mart
11.0 EMERGENCY RESPONSE PLAN
(in compliance with 29 CFR 1910.120(l) and 1910.120(b)(4)(ii)(H)
This is the site-specific emergency response plan. This chapter of the Health and Safety Plan describes potential
emergencies at this site, procedures for responding to those emergencies, roles and responsibilities during emergency
response, and training that workers must receive in order to follow emergency procedures. This plan also describes the
provisions this site has made to coordinate its emergency response planning with other contractors on site and with off-site
emergency response organizations.
11.1 Pre-emergency Planning
This site has been evaluated for potential emergency occurrences, based on site hazards, the tasks within the work plan, the
site topography, and prevailing weather conditions. The results of that evaluation are shown in Table 11-1 below.
This emergency response plan is consistent with the requirements of 29 CFR 1910.120(l) and provides the following site-
specific information:
* pre-emergency planning
* personnel roles, lines of authority, and communication
* emergency recognition and prevention
* safe distances and places of refuge
* site security and control
* evacuation routes and procedures
* decontamination procedures
* emergency medical treatment and first aid
* emergency alerting and response procedures
* critique of response and follow-up
* PPE and emergency equipment
Table 11-1 Potential Site Emergencies
Type of Emergency Source of Emergency Location of Source
11.2 On-Site Emergency Response Equipment
Emergency procedures may require specialized equipment to facilitate worker rescue, contamination control and reduction,
or post-emergency clean-up. Emergency response equipment stocked on this site is listed in Table 11-2. The equipment
inventory and storage locations are based on the potential emergencies described in Table 11-1. This equipment inventory is
designed to meet on-site emergency response needs and any specialized equipment needs that off-site responders might
require because of the hazards at this site but not ordinarily stocked.
Any additional PPE required and stocked for emergency response is also listed in Table 11-2 below. During an emergency,
the Emergency Response Coordinator is responsible for specifying the level of PPE required for emergency response. At a
minimum, personal protective equipment used by emergency responders will comply with Chapter 6, Personal Protective
Equipment, of this HASP.
During the development of this emergency response plan, local, state, and federal agency disaster, fire, and emergency
response organizations were consulted to ensure that this plan is compatible and integrated with the plans of those
organizations. Documentation of the dates of these consultations and the names of individuals contacted is kept at Field
Book.
Emergency response equipment is inspected at regular intervals and maintained in good working order. The equipment
inventory is replenished as necessary to maintain response capabilities.
Collision (person/equipment or
equipment/equipment)
Operator error Vehicles
Lightning Weather outside
High winds - microbursts Weather outside
Hurricane Weather outside
Heat stress/worker collapses employee outside
11 - 1 of 8 Date of Program:Site Name:Former Texaco Food Mart #
Table 11-2 Emergency Equipment and Emergency PPE
Emergency Equipment Specific Type Location StoredQuantity Stocked
Emergency PPE Specific Type Location StoredQuantity Stocked
Decontamination solution unknown one each vehicle
First aid kit unknown one each vehicle
Fire extinguisher unknown one each vehicle
Water unknown varies each vehicle
Gloves nitrile at least one box each vehicle
Eye protection unknown varies each vehicle
11 - 2 of 8 Date of Program:Site Name:Former Texaco Food Mart #
11.3 Emergency Planning Maps
11.4 Roles and Responsibilities for On-Site and Off-Site Personnel
TBD is responsible for implementing the emergency response plan and coordinates emergency response activities on this
site. He/she provides specific direction for emergency action based upon information available regarding the incident and
response capabilities and initiates emergency procedures, including protection of the public and notification of appropriate
authorities.
In the event of an emergency, site personnel are evacuated and do not participate in emergency response activities. As a
result, this emergency response plan is designed to comply with 29 CFR 1910.38. The on-site personnel and their alternates
responsible for coordinating site evacuation efforts are listed in Table 11-4. The emergency response coordinator or one of
his/her alternates is on site whenever work operations are underway.
The site relies upon the off-site emergency response organizations listed in the Emergency Contact Information, Table 11-4,
to respond to site emergencies. These organizations have been provided a copy of the site HASP, have been thoroughly
briefed on site operations, hazards, and potential emergencies; have participated in a site walk-through if necessary; and are
appropriately trained, staffed, and equipped to provide emergency response to this site. These organizations are contacted
at least semi-annually or when changes in operations or hazards occur on site to verify the accuracy of phone numbers and
contact names and to ensure that current points of contact are aware of site operations and hazards.
If evacuation notice is given, site workers leave the worksite with their respective buddies, if possible, by way of the
nearest exit. Emergency decontamination procedures detailed in Chapter 10 of this HASP are followed to the extent
practical without compromising the safety and health of site personnel.
Appropriate primary and alternate evacuation routes and assembly areas have been identified and are shown on the
Emergency Response Map Fig 3-1. The routes and assembly area will be determined by conditions at the time of the
evacuation based on wind direction, the location of the hazard source, and other factors as determined by rehearsals
and inputs from emergency response organizations.
11.5 Emergency Alerting and Evacuation
Wind direction indicators are located so that workers can determine a safe up wind or cross wind evacuation route and
assembly area if not informed by the emergency response coordinator at the time the evacuation alarm sounds.
Contractors and subcontractors on this site have coordinated their emergency response plans to ensure that these
plans are compatible and that source(s) of potential emergencies are recognized, alarm systems are clearly
understood, and evacuation routes are accessible to all personnel relying upon them.
11.6 Emergency Response
The Emergency Response Team Leader, after investigating the incident and reviewing relevant information, determines the level of
response required for containment, rescue, medical care and clean-up. The emergency response team is mobilized to the incident
site and supplied with sufficient members, PPE, and emergency equipment.
When the Team Leader determines that on-site emergency response is inadequate for the emergency or that outside assistance is
needed or otherwise required, the applicable off-site organization shown in Table 11-4 is contacted. The Emergency Response
Personnel exiting the site gather at a designated assembly point. To determine that everyone has successfully exited
the site, personnel will be accounted for at the assembly site. If any worker cannot be accounted for, notification is
given to TBD so that appropriate action can be initiated.
Figure 3-1 provides a map of the site with key on-site emergency planning information clearly marked. Emergency evacuation
route(s), places of refuge, assembly point(s), and the locations of key site emergency equipment are identified on this map, if
applicable. Site zone boundaries are shown to alert responders to known areas of contamination, if known. Figure 3-1is posted at
site entry points and at locations throughout the work site.
Figure 11-3b indicates the route to the nearest emergency medical assistance. Figure 11-3b is posted at the following
locations:
Field Book
Upon discovering an emergency situation, personnel notify TBD, who will evaluate available information and initiate
response. Site workers are alerted to emergencies through the use of an employee alarm system. The employee
alarm systems at this site are listed in Table 11-5.
Type of Alarm Location How Alarm is Used
Table 11-5 Employee Alarm Systems
CATLIN Employee on-site verbal
This alarm system meets the requirements of 29 CFR 1910.165 and is tested (frequency) under normal site operating
conditions to ensure that it is in good working order and can effectively alert all persons on-site. A log of alarm tests is
kept by TBD.
11 - 3 of 8 Date of Program:Site Name:Former Texaco Food Mart #
This site has At least once workers with current first aid certification assigned to provide first aid during each shift. Because of this
practice, the site has an exposure control plan in accordance with OSHA's bloodborne pathogens standard, 1910.1030 (c)(1)(i).
The site also offers Hepatitis B vaccinations to workers who are assigned to provide first aid. A record of those vaccinations or the
employee's declination of the vaccination is kept in her/his medical records file.
Team Leader provides relevant information to the responding organizations, including hazards associated with the emergency
incident, potential containment problems, and missing site personnel.
11.7 Emergency Medical Treatment and First Aid
Personnel who require medical care and/or who are transferred to a medical facility are accompanied by MSDSs and other
applicable hazard data to apprise caregivers of the chemicals and hazards to which the victim has been potentially exposed. The
emergency medical care facility for this site is Wake Forest Baptist Health. The route to the facility is shown in Figure 11-3b.
11.8 Emergency Response Critique and Plan Updates
This emergency response plan is evaluated periodically throughout site operations and updated for accuracy. Changes made to
emergency response procedures as the result of rehearsals or actual response incidents are recorded in this Plan. Site workers
receive notification and training on changes to the Plan by Weekly field crew meetings weekly.
11.9 Emergency Response Training
All persons who enter this worksite, including visitors, receive a site-specific briefing about anticipated emergency situations
and the emergency procedures.
This site relies on off-site organizations for emergency response (see Table 11-4), the training of personnel in those off-site
organizations has been evaluated and is deemed adequate for response to this site.
Site personnel are trained to evacuate in a safe and orderly manner in accordance with 29 CFR 1910.38. Workers do not
participate in emergency response rehearsals at this site.
After every emergency incident or evacuation of this site, Mike D. Mason or Project Manager will evaluate the quality and safety of
response activities. Any deficiencies in response actions will be included in a specific follow-up plan and corrected.
11 - 4 of 8 Date of Program:Site Name:Former Texaco Food Mart #
11 - 5 of 8 Date of Program:Site Name:Former Texaco Food Mart #
Table 11-4 Emergency Contact Information
SITE PERSONNEL
OUTSIDE ASSISTANCE
Title Contact Telephone
Agency Contact TelephoneAddress/Location
Project Manager (PM)Sean O'Neil 9195394403
Site Safety and Health Officer (SSHO)TBD 9104525861
Emergency Response Coordinator (ERC)TBD 9104525861
Site Supervisor TBD 9104525861
Emergency Response Coordinator 1st Alternate 9104525861
Emergency Response Coordinator 2nd Alternate 9104525861
Subcontractor:TBD
Ambulance/EMS 911
Police 911
Fire 911
National Reponse Center 800-424-8802
State Police 911
Local Emergency Response
Agency
911
Emergency Medical
Assistance
On-site Staff Medical Center Blvd, Winston-Salem,
NC 27157
3367169253
Poison Control Center
Secondary Medical Facility
Poison Control Center (your state
agency #)
State Authority
Center for Disease Control
Chemtrec 800-424-9300
The list of telephone numbers below are the emergency contact numbers for this site. These emergency numbers are
verified to be accurate, working numbers. Site personnel are trained and rehearsed in site-specific emergency calling
procedures. A copy of this contact information is posted at the following locations:
Site Field Book
11 - 6 of 8 Date of Program:Site Name:Former Texaco Food Mart #
Figure 11-3a Emergency Planning Map
Insert emergency planning map here.
11 - 7 of 8 Date of Program:Site Name:Former Texaco Food Mart #
Insert map of driving route to Emergency Medical Assistance.
Figure 11-3b Driving Route to Emergency Medical Assistance
11 - 8 of 8 Date of Program:Site Name:Former Texaco Food Mart #
7/26/2021 1700 Cotton Grove Road, Lexington, NC to Wake Forest Baptist Health - Lexington Medical Center - Google Maps
https://www.google.com/maps/dir/1700+Cotton+Grove+Road,+Lexington,+NC/Wake+Forest+Baptist+Health+-+Lexington+Medical+Center,+250+Hos…1/2
Map data ©2021 2000 ft
Lexington, NC 27292
1700 Cotton Grove Rd
Follow Cotton Grove Rd and S Main St
1.Head north on Cotton Grove Rd toward Cedar Ln
Dr
Pass by Arby's (on the right in 0.4 mi)
2.Keep left to stay on Cotton Grove Rd
3.Continue onto E 10th Ave
9 min (4.2 mi)
0.4 mi
2.0 mi
0.2 mi
Drive 4.5 miles, 11 min1700 Cotton Grove Road, Lexington, NC to Wake
Forest Baptist Health - Lexington Medical Center
7/26/2021 1700 Cotton Grove Road, Lexington, NC to Wake Forest Baptist Health - Lexington Medical Center - Google Maps
https://www.google.com/maps/dir/1700+Cotton+Grove+Road,+Lexington,+NC/Wake+Forest+Baptist+Health+-+Lexington+Medical+Center,+250+Hos…2/2
These directions are for planning purposes only.
You may nd that construction projects, trac,
weather, or other events may cause conditions to
differ from the map results, and you should plan
your route accordingly. You must obey all signs or
notices regarding your route.
250 Hospital Dr, Lexington, NC 27292
4.Turn left onto S Main St
Take Hospital Dr to your destination
5.Turn right toward Hospital Dr
6.Continue onto Hospital Dr
7.Turn right
8.Turn right at Hospital Dr
9.Turn left
Destination will be on the left
Wake Forest Baptist Health - Lexington Medical
Center
1.6 mi
2 min (0.4 mi)
0.1 mi
0.1 mi
282 ft
144 ft
207 ft
12.0 Standard Operating Procedures (SOPs)
(in compliance with 29 CFR 1910.120(b)(1)(ii))
Work at this site will be conducted in accordance with the following SOPs, which have been attached for reference.
Sun Exposure 1.
Fire Safety 2.
Snakes, Insects and Plants 3.
Well Gauging 4.
Hand Tools 5.
Well Sampling 6.
Hearing Conservation Program 7.
Environmental Drilling Operations 8.
Trailers and Towed Equipment 9.
12 - 1 of 1 Date of Program:Site Name:Former Texaco Food Mart

Sun Exposure SOP
Information for both on and off the job.
1. By far, the most common cause of skin cancer is overexposure to the sun.
Ninety percent of all skin cancers occur on parts of the body that usually are not
covered by clothing.
2. People who sunburn easily and have fair skin with red or blond hair are most
prone to develop skin cancer. The amount of time spent in the sun also affects a
person’s risk of skin cancer.
3. To reduce the risk of skin cancer:
a. Cover up with a wide-brimmed hat and a bandanna for your neck. Wear long-
sleeved shirts and pants that the sun cannot penetrate.
b. Use sunscreens to help prevent skin cancer as well as premature aging of
your skin.
Use a Sun Protective Factor (SPF) rating of 15 or higher. Women may receive
added protection by using tinted opaque cosmetic foundation along with a
sunscreen. Apply sunscreen at least an hour before going into the sun and again
after swimming or perspiring a lot. Do not use indoor sunlamps, tanning parlors,
or tanning pills.
c. You can still get burned on a cloudy day. Try to stay out of the direct sun at
midday, because sunrays are the strongest between 10 a.m. and 3 p.m. Beware
of high altitudes – where there is less atmosphere to filter out the ultraviolet rays.
Skiers should remember that snow reflects the sun’s rays, too.
4. Know your skin. Whatever your skin type, do a monthly self-examination of
your skin to note any moles, blemishes or birthmarks. Check them once a month
and if you notice any changes in size, shape or color, or if a sore does not heal,
see your physician without delay.

SAFE OPERATING PROCEDURES
Fire Safety/Fire Extinguisher

Buildings
1. All employees should know escape routes and locations of fire exits.
2. All fire exits must be unobstructed, unlocked and marked.
3. Fire/smoke alarms should be tested and fire drills conducted regularly.
4. All employees should know the location of and selected employees know how
to use fire extinguishers. Employee training of fire extinguisher use is required
prior to use.
5. Facilities should be periodically inspected to ensure fire extinguishers are
charged and to identify and eliminate fire hazards. Fire extinguisher locations
should be properly marked.
6. Wiring and/or extension cords used for office machines or other appliances
should be checked periodically.

Job Sites
1. When refueling vehicles, turn off engines. No smoking or open flames are
permitted in the area.
2. Use extra caution when working with flammable materials on job site. Refer to
MSDS.
3. Use only approved marked safety containers for storing and transporting
flammable materials.
4. After refueling portable tools/equipment with gasoline engines, move at least
25 feet from refueling site to start engine.
5. Operator should know the location of and how to use the fire extinguishers.
Fire extinguishers should be inspected monthly to ensure that they are charged.
6. Allow space for fuel expansion in fuel tanks and containers.

SAFE OPERATING PROCEDURES
Poisonous Snakes, Insects and Plants SOP
Like most accidents and injuries, prevention is important in controlling hazards from
poisonous snakes, insects and plants. Therefore, each employee should review the work
activities planned to determine what exposures might exist. Efforts should then be made
to minimize situations, which might result in a snakebite, insect sting or exposure to
poisonous plants. Employees should also avoid wearing bright clothes, perfumes, after-
shaves, etc., to help minimize attraction of snakes or insects.
Snakes
1. Employees should wear work boots, long pants and long sleeved shirts when
going into hazardous areas.
2. Employees should make as much noise as possible when approaching a
possible snake area to give the snake time to leave.
3. Employees should be equipped with a bush axe for clearing underbrush and
for protection.
4. Employees should avoid reaching or stepping into hidden areas whenever
possible.
5. If a snakebite should occur, the employee should:
a) Remain as calm as possible.
b) Move away from the snake.
c) Apply a constricting bandage (not tourniquet) between the wound and heart. A
finger should be able to pass under it. Apply ice to bite area, if available.
d) Allow a fellow worker to transport him/her to closest medical facility.
e) If possible, kill the snake and carry to medical facility for identification.
6. Under no circumstances should incisions and suction be used to treat a
snakebite unless:
a) The victim is over 1.5 hours from medical assistance, and
b) The person administering first aid has received advanced training in medical
assistance such as First Responder, EMT, etc.
Insect Stings
Employees should:
1. Wear appropriate clothing.
2. Avoid areas where insects might be whenever possible.
3. Schedule work in infested areas during the cool months.
4. Avoid high smelling after-shaves, colognes, etc., that may attract insects.
5. Use an insect repellent.
6. If a sting does occur, any stinger should be removed with a knife blade or
fingernail. The area should then be treated with Hydrocortisone.

Ticks
Ticks are especially important to pay attention to because of the possibility of Rocky
Mountain Spotted Fever of Lyme Disease.
To minimize exposure, employees should follow these guidelines:
1. Wear appropriate clothing when working in wooded area.
2. Check yourself at least twice a day, paying particular attention to the hair,
neck, and groin area.
3. Use a Tick Repellent.
4. Notify your supervisor if a tick is found and request that the date and condition
(i.e. attached? crawling?) be noted for future reference. (If possible retain
engorged ticks and place in a container for identification of the tick type by a
CATLIN preferred provider.)
5. Call your CATLIN preferred provider if fever, chills, headaches or muscle
aches develop within 3-10 days after exposure. In some cases, a rash may
develop on the wrists and ankles 1-3 days after the fever begins.

Poisonous Plants
CATLIN employees have exposure to at least three types of poisonous plants: poison oak,
poison ivy and poison sumac. Reactions range from mild (very little or none) to severe
(rash and blisters). Employees who have no reaction may not have become sensitized, but
once they are, future exposures can result in an allergic reaction.
To avoid problems with poisonous plants, employees should:
1. Avoid working in severely infested areas if at all possible. (Learn what the
plants look like.)
2. Wear long sleeve shirts, long pants, and work gloves. If you are performing
clearing activities with either hand (e.g. bush axes, machetes, etc.) or powered
tools use eye goggles/Safety glasses to prevent poisonous plants from entering
your eyes.
3. Use silicone protective or other barrier creams where available.
4. Make sure that any clothes or shoes that may have been exposed receive
thorough washing. Leftover oils on anything could cause a reaction even days
later.
5. If a severe reaction develops, contact your CATLIN preferred provider for
possible treatments.
6. Avoid rubbing your eyes if you have been in contact with poisonous plants.

SOP - WELL GAUGING 1 of 6 Revised February 2009
CATLIN STANDARD OPERATING PROCEDURES
WELL GAUGING

1. PURPOSE AND SCOPE:

This document outlines CATLIN’s Standard Operating Procedure for determining depth
to groundwater and measurement to product (if present) in a monitoring well. The
document details gauging with an electronic water level indicator (probe) as well as
using a metal engineering tape with free-phase product and water finding paste.
Please note that free-phase product is considered by CATLIN to be synonymous with
Light Non-Aqueous Phase Liquids as it relates to this document.

Based on previously determined top-of-casing elevations, these measurements may
ultimately be used to calculate hydraulic gradients, determine direction of
groundwater flow at the site, and estimate free-phase product thickness (if present)
in the subsurface. The calculations for these determinations are not included in this
Scope.

Be sure to obtain the most recent field data forms and well information for the
subject site. Please keep in mind that well information can be obtained from gINT.

2. EQUIPMENT LIST:

Safety/Personal Protective Equipment (PPE) Items

___ Appropriate personal protective equipment (PPE) gloves
___ First aid kit
___ Traffic cones
___ Appropriate PPE for contaminants of concern

Measurement Items

___ Site map
___ Replacement lock and cap (be sure to bill to client)
___ Field Book (Daily Sheets and Water Elevation Sheets)
___ #2 Pencil or pen for record keeping
___ Hammer
___ Wrenches
___ Socket set up to 15/16” (9/16” and 15/16” typical)
___ Screwdriver
___ Something to remove water from well shield (i.e. turkey baster, jar, bottle, boat
pump, sponge)
___ Appropriate keys for job site
___ Bolt cutters (just in case)
___ Saw (mark with a notch in high spot on TOC if none)
___ Sharpie (permanent marker)
___ Water and product paste
___ Measuring tape or electronic level indicator
___ T-handle wrench
___ Extra battery for electronic probes

SOP - WELL GAUGING 2 of 6 Revised February 2009

Decontamination
___ Paper towels
___ Trash bags
___ Spray bottle with phosphate-free detergent/water
___ Distilled water and spray bottle with distilled water
___ Spray bottle with diluted alcohol; pesticide-grade isopropyl alcohol (isopropanol, 2-
propanol) mixed with 1:10 alcohol and distilled water

3. GENERAL INFORMATION:

The following information is critical and pertinent to either of the gauging procedures
described in Section 4 and should be reviewed prior to leaving the office.

a. NO MATH SHOULD BE PERFORMED IN THE FIELD PRIOR TO
RECORDING DATA. This essentially means that you should not “calculate”
measurements in your head. Record each measurement directly onto the
CATLIN “Groundwater Elevations” field form (attached). Calculations for
depth to water and product thickness will be completed after recording all
data.
b. Use the appropriate PPE and clothing (rain gear) suitable for site conditions
(check with project manager!).
c. If historical data is available, review carefully so that you can gauge
historically “clean” wells first and historically “dirty”, recovery, or free product
wells last.
d. If practical, open all wells prior to gauging in order to ensure that the
groundwater equilibrates.
e. Final measurements (for groundwater contouring) will be taken in monitoring
well no sooner than 24 hours after completion of well development activities.
f. For preparation of groundwater elevation maps and hydraulic gradient
calculations, all monitoring wells will be measured on the same day.
g. Make sure that the probe or metal tape is of sufficient length to reach the
water table at your site. Some of our tapes are only 25 feet in length, which is
not long enough to determine depth to water at some of our sites.
h. For wells with shallow surficial water tables, you may be able to look into the
well and see the surface of the water. This allows for ease in measurement,
especially when using the metal tape method as you are able to observe the
probe/tape entering the groundwater.

SOP - WELL GAUGING 3 of 6 Revised February 2009
4. GAUGING PROCEDURES:

CATLIN typically uses one of two procedures for determination of depth to water:
(1) the electronic water level indicator (or oil/water interface probe), and (2) the metal
engineers tape with water and product finding paste. Whichever procedure you use,
be consistent. The two procedures do not necessarily result in the same
measurement, so do not use both procedures for different wells gauged at the
same site on the same day! The following information details some characteristics
of each method:

• The water level probe may not be used when free-product is present due
to potential damage to equipment and inaccurate reading.
• The water level indicator is generally faster, but less accurate and precise.
• The water level indicator helps to minimize the risk of “missing” the top of
the water surface the first attempt.
• The metal engineers tape is more dependable, accurate, precise, and
allows for determination of depth to product by using product-finding
paste.
• Never use a “plumb-bob” or weight at the end of a probe or tape. This can
cause water displacement and give an inaccurate measurement.

The following sub-sections summarize the procedures for each method for
determining the depth to water.

Method 1 – Electronic Level Probe

1. Starting with the cleanest well, remove protective cover from each wellhead.
2. Unlock and remove the expandable locking well cap.
3. Allow each well at least a few minutes to equilibrate prior to taking the
measurement.
4. Properly decontaminate the probe tip prior to use (Refer to Section 5). Do
not use alcohol of any kind on the probe tip. Use distilled water or wipe
outside of probe tip with alcohol on paper towel.
5. Turn on the water level probe. Test to make sure the battery is good and the
instrument is working properly. Take extra battery. Be sure to attach
grounding cable for interface probe before taking measurements.
6. Starting with the cleanest well, slowly lower the probe into the well until the
audible sound indicator emits a beep or buzz. Interface probe will emit one
signal for product and another for water. Verify with the equipment manual.
You may need to work the tape up and down to get the exact point at which
the probe intersects the water or free-phase product.
7. Record the Well ID on the Groundwater Elevations field form (attached).
8. Record the point where the probe tape intersects the well top-of-casing under
“Tape Held On (B)” on the Groundwater Elevations field form. IF there is no
product present, this measurement is also equal to “Depth to Groundwater
(E).” This measurement should be to the nearest 0.01 foot.
9. If depth of well is needed, use a tape. Extend the tape to the bottom of the
well, and record the well “total depth” on your daily field log.
10. Withdraw the probe or tape and decontaminate in accordance with Section 5.
11. Replace and lock the expandable cap, and secure the well shield.
SOP - WELL GAUGING 4 of 6 Revised February 2009

Method 2 – Metal Engineers Tape (For wells with or without product)
(Refer to Figure 1)

1. Starting with the cleanest well, remove protective cover from each wellhead.
This may be a bolt of various sizes or a specialty bolt for flush mount wells.
Aboveground well shields will have a hinged cover with one of our standard
locks.
2. Unlock and remove the expandable locking well cap.
3. Allow each well a few minutes to equilibrate prior to taking the measurement.
4. Properly decontaminate the tape prior to use (Refer to Section 5).
5. Some tapes may be dedicated for free product use. Do not use one of these
tapes in a “clean” well or well without product.
6. Start with the cleanest well.
7. Smear a thin coating of water finding paste lengthwise along one half of the
tape, from the end of the tape to a point between the 1.0 and 2.0-foot mark.
Be careful not to completely obscure the numbers.
8. Smear a thin coating of product finding paste lengthwise along the other half
of the tape. Extend this line above the end of the water finding paste. Be
careful not to completely obscure the numbers. The length of the product
paste smear may vary to several feet depending on the product thickness in
the well.
9. Record the Well ID on the Groundwater Elevations field form.
10. Slowly lower the tape into the well until the tape intersects the water/product
surface (s). Advance the tape to the nearest 0.5 or 1.0 foot interval.
11. Record the point where the tape intersects the well top-of-casing under “Tape
Held On (B)” on the Groundwater Elevations field form. This measurement
should be to the nearest 0.01 foot.
12. Slowly withdraw the tape from the well.
13. If product is present, record the measurement at which the product paste
changes color under “Product Cut (C)” on the field form. Record “NMT” if no
product present.
14. Record the measurement at which the water finding paste changes color
under “Groundwater Cut (D).”
15. Figure 1 illustrates a typical measurement from a well with product present.
16. If information needed, extend the tape to the bottom of the well and record the
“total depth” on your daily field log. Decon per number 12.
17. Properly decontaminate the tape prior to gauging the next well in accordance
with Section 5.
18. Replace and lock the expandable cap and secure the well shield.

SOP - WELL GAUGING 5 of 6 Revised February 2009

SOP - WELL GAUGING 6 of 6 Revised February 2009
5. DECONTAMINATION PROCEDURES:

The measuring device will be decontaminated between wells in the following
manner:

• Spray the tape/probe with the alcohol, water or detergent/water mixture first.
• Rinse with distilled water.
• Wipe with paper towel.
• Repeat as necessary.
• Waste paper towels and PPE shall be properly disposed of (on-site if possible).
• Site-specific decontamination procedures may supersede standard operating
procedures.

6. RECORDING / DEMOBILIZATION:

• Record start and stop times for gauging activities on Daily Activities Sheet.
• For preparation of groundwater elevation maps, calculate a complete set of water
elevations from the same day as shown on the attached Groundwater Elevations
field form.
• Restock all used materials.
SOP - WELL SAMPLING (Standard) Page 1 of 4 Revised February 2009
CATLIN STANDARD OPERATING PROCEDURES
WELL SAMPLING (STANDARD)

1. PURPOSE AND SCOPE:

This document outlines CATLIN’s Standard Operating Procedure for obtaining a
groundwater sample from a monitoring well using standard procedures (non-low flow
procedures).

Be sure to obtain the most recent field data forms and well information for the
subject site. Please keep in mind that well information can be obtained from gINT.

Regulatory Considerations:
• Be sure to understand the regulatory authority that is responsible for oversight of
this project. The PM will provided details on the impacts that the Regulatory
Authority may have on the sampling.
• Keep in mind sampling for each regulatory authority is generally the same with
the main difference being associated with QA/QC samples and appropriate test
methods.

2. EQUIPMENT LIST:

Safety/Personal Protective Equipment (PPE) Items
___ Appropriate personal protective equipment (PPE) gloves
___ First aid kit
___ Traffic cones
___ Appropriate PPE for contaminants of concern

Sampling Items

___ Replacement lock and cap (be sure to bill to client)
___ Hammer
___ Wrenches
___ Socket set up to 15/16”
___ Screwdriver
___ Something to remove water from well shield (i.e. turkey baster, jar, bottle, boat pump,
sponge)
___ Appropriate Keys (at least 0536 and 3247 for NC projects and dolphin locks for GA
projects)
___ Bolt Cutters (just in case)
___ Saw (mark with a notch in high spot on TOC if none)
___ Sharpie (permanent marker)
___ Water and product paste
___ Measuring tape or electronic water level indicator
___ T-handle wrench
___ String

SOP - WELL SAMPLING (Standard) Page 2 of 4 Revised February 2009
___ Bailers or pump and tubing
___ Weighted fishing lure – Treble Hook (no lead)
___ 5-gallon bucket
___ 55-gallon drum (if required)
___ Knife
___ Ice
___ Cooler
___ Glassware
___ labels
___ baggie/ziploc
___ duct tape if shipping
___ custody seal
___ watch
___ calculator
___ Applicable field parameter equipment. Be sure to calibrate equipment prior to use and
document on appropriate CATLIN Calibration Logs.
___ Plastic for around well and under equipment.

Decontamination
___ Paper towels
___ Trash bags
___ Spray bottle with phosphate-free detergent/water.
___ Distilled water and spray bottle with distilled water
___ Spray bottle with diluted alcohol; pesticide-grade isopropyl alcohol (isopropanol, 2-
propanol) mixed with 1:10 alcohol and distilled water

Paper Work Items
___ Field book (daily activities sheet with water elevations sheet, maps, sampling
worksheet, COC)
___ Appropriate figures/maps (i.e. plume map and others)
___ #2 pencil/pens
___ Shipping paper work (FedEx, UPS, DHL)
___ Historical data (if applicable)

3. PROCEDURES:

BEFORE LEAVING THE OFFICE:
• Gather equipment – use the checklist above.
• Meet with PM on paperwork needed and how it should be completed.
• Determine laboratory QA/QC samples needed.
• Call site to notify that you’re coming, if necessary.
• Verify proper equipment for developing wells - check for pump size and depth of
wells. Check with PM for applicable method for developing wells.
• Check glassware against bottle order against for what you are sampling.
• Be sure to sign out equipment and vehicle.

SOP - WELL SAMPLING (Standard) Page 3 of 4 Revised February 2009

AT SITE:
• Get ice before sampling.
• Check in at site with appropriate personnel, if necessary.
• If you are familiar with the site, gauge and sample clean wells first then
contaminated wells.
• Fill out labels as much as possible and glassware.
• Place plastic around well – approximately 4’ x 4’ area.
• Gauge wells according to CATLIN Well Gauging SOP.
• Fill out well sampling worksheet and determine volume to remove or number of
bails prior to sampling.
• Purging is conducted with pumps or bailers.
• Purge three volumes or until dry. If well is purged dry, allow water to recharge
and collect sample.
• Dispose of purge water appropriately (check with PM).
• If using a bailer, be sure not to let the string hit the ground.
• Sample with bailer or pump.
• Lower bailers slowly into water column.
• The order of sample container filling should proceed from most volatile to least
volatile compounds.
• Collect samples required with zero headspace for volatile organic analysis (VOA)
vials to obtain minimum headspace for others.
• If filling glassware containing a preservative, don’t overfill the sample jar.
• Immediately place samples on sufficient ice in a cooler to maintain less than 4°C
until it arrives at the laboratory.
• Collect appropriate number of QA/QC samples.
• Complete labeling of the sample jars.
• Fill out chain of custody (COC) COMPLETELY and accurately and neatly. If not
sure of any information on the form, be sure to verify with PM.
• Clean site and handle investigative derived waste appropriately.
• Replace locking well cap, lock and secure well head.
• Deliver samples to laboratory within appropriate hold times on sufficient ice.
Request applicable Electronic Data Deliverable (EDD) format on COC if
necessary. Also put appropriate quote number on the COC.
• When returning to the office, return equipment to proper place and be sure to fill
out equipment log for billing purposes.
• Fill out mileage log properly.
• Make sure to have debriefing with PM after returning to the office. This can be
accomplished via telephone.

4. DECONTAMINATION PROCEDURES:

The sampling equipment is to be decontaminated between wells in the following
manner:

• Spray the reusable items with the alcohol, water or detergent/water mixture first.
• Rinse with distilled water.
SOP - WELL SAMPLING (Standard) Page 4 of 4 Revised February 2009
• Repeat as necessary.
• Waste paper towels, PPE and non-reusable items shall be properly disposed of
(on-site if possible).
• Site-specific decontamination procedures may supersede standard operating
procedures.

5. REPORT:

• Record required information on the CATLIN Sample Record Form, laboratory
Chain-of-Custody and labels, and all other forms requested by the PM.
• Put copy of Chain of Custody in field book.

13.0 PERMIT-REQUIRED CONFINED SPACES
(in compliance with 29 CFR 1910.120(b)(4)(ii)(I) and 1910.146)
This permit-required confined space program (permit space program) includes the elements specified in 29 CFR
1910.146 and provides the following site-specific information:
* identification and evaluation of permit spaces
* measures to prevent unauthorized entry
* entry permit system
The person with overall responsibility for the permit space program is Project Manager. The permit space program is
modified to reflect changing site conditions or work operations. This program is reviewed if any of the following
conditions occur:
This site has been carefully evaluated by Project Manager on 11/11/2020 and there are no confined spaces on this site.
This section of the Health and Safety Plan represents the site-specific written confined space entry program. The purpose
of this section of the Health and Safety Plan is to identify all permit-required confined spaces (permit spaces) on site and
to describe the procedures that have been developed and implemented to ensure worker safety and health in permit-
required confined spaces. In compliance with the requirements of 29 CFR 1910.120(b)(4)(ii)(I), this section of the HASP
is included even when no permit-required confined spaces are present on site in order to indicate that a site-specific
evaluation for permit spaces has been made.
* entry equipment and personal protective equipment
* permit spaces training
* rescue and emergency procedures
* employee participation
* entry procedures
* occurrence of unauthorized entry of a permit space
* discovery of a permit space hazard not covered by the permit
* detection of a condition prohibited by the permit
* occurrence of a injury or near-miss during entry
* employee complaints of permit space program ineffectiveness
* change in the use or configuration of a confined space
Additionally, an annual review of all entries performed during the previous 12 month period is conducted. If no entries
were made into a permit space, then no annual review is performed.
13.1 Identification and Evaluation of Permit Spaces
13 - 1 of 1 Date of Program:Site Name:Former Texaco Food Mart
14.0 HOT WORK
(in compliance with 29 CFR 1910.252(a))
An evaluation concluded that no welding or cutting would occur on this site. For that reason, no hot work program is
implemented for this site.
14 - 1 of 2 Date of Program:Site Name:Former Texaco Food Mart
14 - 2 of 2 Date of Program:Site Name:Former Texaco Food Mart
15.0 Energy Control or Lockout/Tagout Program
(in compliance with 29 CFR 1910.147)
This section of the Health and Safety Plan represents the site-specific hazardous energy control program. The purpose of this
section of the Health and Safety Plan is to identify all machine and equipment repair and maintenance activities that require
LOTO procedures under 1910.147.
This site was carefully evaluated by Project Manager on 11/11/2020 and it was determined that LOTO procedures are not
necessary for any machines or equipment to protect site employees from hazardous energy. This section of the HASP is
included even when the employer is not covered by 1910.147 in order to indicate that a site-specific evaluation for the control of
hazardous energy has been made.
[NOTE: The employer may want to indicate the specific reason they are not covered by the LOTO standard, especially in cases
where repair and maintenance of machines or equipment on the site is necessary. If an employer is exempt because of normal
production operations (1910.147(a)(2)(ii)), hot tap operations (1910.147(a)(2)(iii)(B)), or other reasons, he/she should note the
reason for the LOTO exemption.]
15 - 1 of 1 Date of Program:Site Name:Former Texaco Food Mart

____________________________________________________________________________________NCDEQ; 22332_Former Texaco Food Mart #2 CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021
ATTACHMENT C SITE PHOTOGRAPHS
ATTACHMENT C SITE PHOTOGRAPHS – AUGUST 10, 2021
NCDEQ; 22332_Former Texaco Food Mart #2_Site Photos CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021

View of assumed location for MW-3, facing northwest.

View of assumed location of MW-6, facing southwest.

ATTACHMENT C SITE PHOTOGRAPHS – AUGUST 10, 2021
NCDEQ; 22332_Former Texaco Food Mart #2_Site Photos CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021

View of unknown monitoring well.

View of unknown monitoring well, facing north.

ATTACHMENT C SITE PHOTOGRAPHS – AUGUST 10, 2021
NCDEQ; 22332_Former Texaco Food Mart #2_Site Photos CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021

Assumed location of T-1, T-3 and MW-2, facing east.

View of assumed location for T-2, facing north.

ATTACHMENT C SITE PHOTOGRAPHS – AUGUST 10, 2021
NCDEQ; 22332_Former Texaco Food Mart #2_Site Photos CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021

Assumed location of MW-1, facing east.

Assumed location of MW-4, facing southwest.

ATTACHMENT C SITE PHOTOGRAPHS – AUGUST 10, 2021
NCDEQ; 22332_Former Texaco Food Mart #2_Site Photos CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021

Location of MW-5 (bottom center of picture between the green leafy plants), facing south.

New parking lot put in behind the subject site.

ATTACHMENT C SITE PHOTOGRAPHS – AUGUST 10, 2021
NCDEQ; 22332_Former Texaco Food Mart #2_Site Photos CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021

View of the back of the new building on site.

View of front of new building on site.

ATTACHMENT C SITE PHOTOGRAPHS – AUGUST 10, 2021
NCDEQ; 22332_Former Texaco Food Mart #2_Site Photos CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021

View of former UST location.

View of powerlines around the side, facing west.

ATTACHMENT C SITE PHOTOGRAPHS – AUGUST 10, 2021
NCDEQ; 22332_Former Texaco Food Mart #2_Site Photos CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021

View of powerlines behind the building, facing east.

View of MW-5 filled with concrete.

____________________________________________________________________________________NCDEQ; 22332_Former Texaco Food Mart #2 CATLIN Engineers and Scientists
CATLIN Project No. 221185 September 2021
ATTACHMENT D TABLE
Page 1 of 2TABLE 1PUBLIC AND PRIVATE WATER SUPPLY WELLS AND OTHER RECEPTOR INFORMATIONIncident Name and No.: Former Texaco Food Mart #2 - 22332Well ID Property AddressReal Estate Identification Number (REID)Owner NameOwner MailingAddressWell UseDistance / Direction from Source Area (feet)CommentWSW-11710 Cotton Grove Rd.6723-02-69-6905 Lopp, Bruce W. P.O. Box 284Lexington, NC 27293Potable, Active550 / SSE Potable well confirmed by resident.WSW-2 104 Fuller St. 6724-04-60-9244 Baker, Paul & Stella104 Fuller St.Lexington, NC 27292Not in use* 610 / SEReceptor questionaire returned to sender as undeliverable. Assumed non-potable and inactive based on previous receptor survey.WSW-3 106 Fuller St. 6724-04-70-0620 Fuller, Margaret106 Fuller St.Lexington, NC 27292Not in use* 640 / NEReceptor questionaire not returned, active Davidson Water account. Assumed non-potable and inactive based previous receptor survey.WSW-4115 Cedar Lane Dr. 6724-04-50-4349Martin, David & Martha1648 Arrington Dr.Lexington, NC 27295Potable, Active980 / WSW Potable well confirmed by resident.WSW-5 6 Mayfair Rd. 6723-02-69-6747E.E. Wilson Investments, LLCP.O. Box 2014Lexington, NC 27293Non-potable, Inactive705 / SSEPublic water use confirmed by resident, active Davidson Water account.WSW-6 8 Mayfair Rd. 6723-02-69-7747 Bee, Bethany D.196 Woodwind Dr.Lexington, NC 27295Non-potable, Inactive725 / SSEPublic water use confirmed by resident. Well on-site not in use.WSW-7 100 Mayfair Rd. 6723-02-69-8779 Davis, Deborah G.100 Mayfair Rd.Lexington, NC 27292Non-potable, Inactive720 / SEPublic water use confirmed by resident; non-potable well.WSW-8 108 Mayfair Rd. 6723-02-79-1871 D.L. Hoffman, LLC711 Overbrook Dr.High Point, NC 27262Potable, Active 950 / SE Potable well use confirmed by resident.WSW-9 130 Fuller St. 6724-04-70-3350E. Lexington Congregation of Jehovah's Witnessc/o Paul Carder208 Maxwell Dr.Lexington, NC 27295Non-potable, Inactive1,025 / ESEWell is capped and covered with rocks; not in use per owner.NCDEQ; 22332_Former Texaco Food Mart #2.xlsx; T1_WSW InfoCATLIN Project No. 221185CATLIN Engineers and ScientistsSeptember 2021
Page 2 of 2TABLE 1PUBLIC AND PRIVATE WATER SUPPLY WELLS AND OTHER RECEPTOR INFORMATIONIncident Name and No.: Former Texaco Food Mart #2 - 22332Well ID Property AddressReal Estate Identification Number (REID)Owner NameOwner MailingAddressWell UseDistance / Direction from Source Area (feet)CommentWSW-10 103 Mayfair Rd. 6723-02-79-0509Bordonaro, Matthew and Elizabeth103 Mayfair Rd.Lexington, NC 27292Potable,Active1040 / SEWell used for drinking and irrigation per owner response. Owner indicated well depth is 100 feetWSW-11 102 Mayfair Rd. 6723-02-69-9779Krueger, Hermann and Maria102 Mayfair Rd.Lexington, NC 27292Non-potable,Inactive855 / SEPublic water use confirmed by resident and active Davidson Water account. Well on-site not in use.WSW-12 104 Mayfair Rd. 6723-02-79-0789Tetter, John and Joyce104 Mayfair Rd.Lexington, NC 27292Non-potable,Inactive905 / SEPublic water use confirmed by resident and active Davidson Water account. Well on-site not in use.Water supply well location and details are based on observations and information collected during a field survey conducted on August 10, 2021.* = Information obtained from prior receptor survey reported by ARM, 2014.Property data was obtained from the Davidson County GIS data viewer, accessed September 2021.NCDEQ; 22332_Former Texaco Food Mart #2.xlsx; T1_WSW InfoCATLIN Project No. 221185CATLIN Engineers and ScientistsSeptember 2021