DSHW-2024-004915

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SITE INVESTIGATION PLAN
LAUNDRY SUPPLY COMPANY
3785 West 1987 South
Salt Lake City, Utah
Prepared for:
Parsons Behle &, Latimer
201 South Main Street, Suite 1800
Salt Lake City, IJtah 841 45-0898
Prepared by:
JBR Environmental Consultants, Inc.
8160 South Highland Drive
Sandy, IJtah 84093
November 10, 1997
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TABLE OF CONTENTS
1.0 INTRODUCTION .. .... . 1
2.O.PREVIOUSINVESTIGATION ......1
3.0 scoPEoFwoRK .......1
3.1 Soil and Ground Water Testing . . . . .2
3.2 LaboratoryAnalysis ....5
4.0 REPORTING .....6
5.0 SCHEDULE ,.....6
6.0 REFERENCES. ........6
LIST OF FIGTJRES
Figure 1 Location Map
Figure 2 Neighborhood Map
Figure 3 Site Map
Figure 4 Typical Monitor Well Construction
LIST OF APPENDICES
Appendix A Health and Safety Plan
Appendix B Quality Assurance/Quality Control Plan
JBR ENvInoNMENTAL CoNSULTANTS, INC.
LauNony SUpPLY CoIrIpaNy SIrp INvpSTIGATIoN PIauI
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1.0 INTRODUCTION
Laundry Supply Company operates as a dishibutor of laundry and dry cleaning supplies from its
offices and warehouse located at3785 West 1987 South in Salt Lake City, Utah (see Figure 1).
On April 4,1996, Laundry Supply closed two underground storage tanks (USTs) and associated
undergroturd piping, equipment, and containment systems (collectively, UST system) located at
the facility which had been used for storage of perchloroethylene (PCE) (see Figure 2). During
the removal, no evidence of a PCE release from either 10,000-gallon tank was observed.
However, based on the results of the laboratory analysis of soil and ground water samples
collected during the closure, Laundry Supply determined that PCE had been released to soil and
ground water from the UST system.
Laundry Supply reported the release to the State on May 2 and again on May 4,1996. In
addition, Laundry Supply filed a UST Closure Notice dated June 4, 1996 with the Division of
Environmental Response and Remediation indicating that PCE had been released. On July 10,
1996, Laundry Supply met with authorized representatives of the Division of Solid and
Hazardous Waste (DSHW) to discuss options in responding to the release. At that meeting, it
was determined that additional investigation of the release was necessary to determine if
remediation to alleviate a potentialhazardto human health or the environment at this site was
warranted. As a result, the parties decided to resolve this matter by entering into a Stipulation
and Consent Agreement to develop a plan for site investigation and remediation such that any
residue, contaminated soil, water or other material resulting from the release would not present a
hazardto human health or the environment. This Site Investigation Plan describes the proposed
activities related to confirming the nature and determining the extent of the reported release.
2.0 PREVIOUS INVESTIGATION
The June 4,1996 UST Closure Notice filed with the State included laboratory results that
showed: 1) PCE in two ground water samples containing concentrations of 22,000 and 180,000
ugll;2) PCE in four soil samples ranging in concentration from <2.0 (non-detect) to 11,000
ug/kg; and, 3) the soil sample submitted for grain-size analysis was determined to be a silty soil
(ML). As part of the UST closure, Laundry Supply installed a vertical PVC pipe in the UST
excavation during backfilling to allow later inspection of ground water conditions.
3.0 SCOPE OF WORK
The scope of work will include the testing of soils and ground water for PCE and related
substances that may occur as a result of the natural degradation of PCE. Also, other samples and
information may be gathered during the sampling activities that will aid in the overall site
JBR ENvInoNMENTAL CoNSULTANTS, INC.
LauNoRY SUPPLY CoupaNY SITE INVESTIGATIoN PIaN
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charucterization that may be required if further site investigation or remediation is warranted.
PCE is a dense non-aqueous phase liquid (DNAPL) that is heavier than water and is only slightly
soluble in water. Based on these characteristics, any PCE that may be present may occur in
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different phases: 1) dissolved in ground water; 2) as subsurface accumulations of free product in
"low spots" on less permeable sediment horizons; and 3) coatings on soil particles through which
dissolved or free-product phases have migrated. Investigations of subsurface DNAPL releases
typigally minimize the extent of drilling that may spread the contamination to greater depths.
These investigations also require obtaining detailed information on subsurface sediments that
may help in identifuing migration pathways of dissolved and free-product phases and the
location of free-product accumulation.
The work will be based on the drilling of soil borings, collection of soil samples, installation of
monitor wells, and the collection of ground water samples from selected locations (see Figure 3).
This work will include the use of truck-mounted drilling equipment and support equipment such
as a pressure washer or steam cleaner and pick-up trucks.
Several 55-gallon drums will be used to store drill cuttings (soil and rock) and ground water
produced from the drilling and sampling activities. The drums will be stored on site pending the
selection of disposal options which will be based on the contaminant concentrations encountered.
If the drum contents are determined to be hazardous waste, the containers will be appropriately
labeled, dated, and stored for no more than 90 days prior to disposal at an appropriate facility.
Work will be conducted according to methods discussed in the Health and Safety Plan (HASP)
included in Appendix A and the Quality Assurance and Quality Control (Q{QC) Plan included
in Appendix B. A photo-ionization detector (PID) will be used to detect organic vapors in soil
samples and in the ambient air in the work area as described in the HASP. Any activities that
may be required and not described in this Site Investigation Plan will be submitted and approved
by the DSHW prior to implementation.
3.1 Soil and Ground Water Testing
Soil and ground water beneath the Laundry Supply Company property will be tested for the
presence of PCE and related degradation products (see Section3.2). The results of this testing
are intended to define the extent of any subsurface PCE-related soil contamination on the
property. The scope of the sampling activities to be performed will be re-evaluated as sampling
results are received and reviewed. Any substantial changes to the subsequent scope of work
described here that appear warranted based on the initial results of the investigation will be
discussed and approved by the DSHW. Soil and ground water sampling will be performed using
a hydraulic drive-point (HDP) system. Additional sampling may be performed by using a
hollow-stem auger (HSA), if warranted.
JBR ENvInoNMENTAL CoNSULTANTS, INc.
LaUNoRY SUPPLY COITIpaNY SITE INVESTIGATIoN PI-aN
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Hydraulic Drive-P oint (HDP) B orings
The HDP system will collect soil and ground water samples from a minimum of 12 locations.
These "borings" are expected to be completed to depths ranging from l0 to 25 feet depending
upon the depth to ground water and the depth to the underlying aquitard. The 8-foot diameter
USTs were installed to a depth of approximately 9 feet. The depths of these borings will be
minimized in an attempt to avoid spreading any contamination encountered to greater depths.
However, drilling will continue to depths where either contamination from the subject release is
no longer encountered or until subsurface conditions are encountered which dictate that the
spread of contamination to lower depths is unlikely (e. g., encountering a substantial thickness of
clay). Soil samples, collected at a minimum of five-foot intervals, will be logged (described) to
provide detailed information related to the nature of the sediments and their potential to provide
preferential pathways or barriers to contaminant migration. Also, detailed depth measurements
will be made while advancing the borings in an attempt to provide datato construct isopleths of
sediment surfaces that may influence contaminant migration. If warranted, continuous geologic
logging and stratigraphic depth measurements will be performed on selected HDP borings. Well
collars will be surveyed by a licensed surveyor to accurately establish the ground water and
stratigraphic gradients. The soil samples will be tested for the presence of organic vapors
through the use of a PID. Any odors present will also be noted.
Depending on the results of the initial 12 HDP borings, additional phases of HDP borings may be
required to further delineate the extent of contamination prior to selecting locations of the HSA
borings. The approximate locations of the 12 HDPs are shown on Figure 3. These approximate
locations may change as the results of the investigation are received and reviewed. The locations
of the initial borings were selected to determine if contamination has spread laterally from the
tank excavation and to what depth. If the lateral extent of contamination is not defined by these
initial borings, the additional borings will be required. The DSHW will be notified of any plans
to drill more than the 12 HDP borings initially planned.
Hollow Stem Auger (HSA) Borings
If the results of the HDP boring progftlm indicate that further investigation is required, three
HSA borings will be drilled on the property by a State-licensed well driller to provide ground
water measurements and the ground water flow direction in the shallow unconfined aquifer.
Once the ground water gradient is established, additional wells may be required to properly
monitor up- and down-gradient locations. If warranted, a fourth HSA boring will be drilled to
provide monitoring of deeper ground water to demonstrate that the reported release has not
impacted deeper ground water. Decisions regarding the drilling of the HSA borings will be made
in consultation with the DSHW. Information on, and descriptions of, the subsurface sediments
JBR ENvInONMENTAL CoNSuLTANTS, INC.
LAUNNRY SUPPLY CoupaNY SITE INvESTIGATIoN PIaN
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encountered would be collected from these borings as described above for the HDP borings. The
three wells intended to monitor the shallow unconfined aquifer are anticipated to be completed at
depths ranging from 10 to 25 feetdepending upon the depth of ground water and the depth to the
underlying aquitard. Soil samples will be collected and analyzed from the shallow HSA borings
if the results of the HDP borings suggest that contamination has likely spread to the HSA
locations.
Only after the drilling and laboratory results from the (approximately) 12 HDP and 3 shallow
HSA borings have been reviewed, would the exact location for the deeper (fourth HSA) monitor
well be selected. In this way, the possibility of drilling through any contamination that may be
present and spreading it to greater depths can be minimized. The deeper well is anticipated to be
drilled to a depth of approximately 40 to 70 feet. This well will be completed at a depth where
the first evidence of confining conditions are observed (e. g., evidence of artesian conditions or
evidence suggesting that a substantial aquitard has been penetrated) and where the aquifer
exhibiting that evidence can be selectively monitored (effectively isolated from the shallow
unconfined aquifer using a bentonite seal). Soil samples will be collected and analyzed from the
deep HSA boring if the results of the previous drilling suggest that it is waranted. However, it is
likely that a water sample collected and analyzed from the confined aquifer would be sufficient
to investigate the potential impact to the confined aquifer. This is because the contamination in
the dissolved phase is likely more mobile than any free product that would migrate through the
sediments. Because the dissolved phase is more mobile, ground water is the preferred medium to
test for impacts.
The ground water monitoring wells completed in the HSA borings will be constructed with 2-
inch Schedule 40 PVC using 0.010-inch slotted screen. Stainless steel well casing and screen
may be used if warranted. A standard completion using washed sand pack (approximately 10-20
size), bentonite, and cement with flush-mounted well covers will be used. Figure 4 shows a
typical monitor well design.
The approximate locations of the 4 HSA borings are shown on Figure 3. The DSHW will be
notified of any plans to drill more than the 4 HSA borings initially planned.
Sample Collection and Handling
Generally, soil and ground water samples will be collected in a manner to minimize sample
disturbance and the subsequent loss of volatile organic compounds. Soil samples will be
collected on five-foot intervals, at a minimum, and submitted for laboratory analysis. Samples
will be placed into sample jars leaving as little head space as possible. Ground water samples
will contain no headspace. The sample containers used will be laboratory-supplied and
specifically designed for the analytical procedures requested. Once collected, samples will be
JBR ENvInoNMENTAL CoNSULTANTS, INc.
LaUNORY SUPPLY COTTIpnNY SITE INVESTIGATIoN PIaN
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Abandonment of Monitor Wells and Soil Borings
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t placed on ice in a cooler pending delivery to the laboratory. Chain-of-custody protocol will be
maintained during sample storage and transportation to the laboratory. Disposable sampling
I equipment will be used to minimize the use of decontamination procedures. Sampling
I equipment to be reused will be decontaminated using a laboratory grade phosphate-free detergent
followed by rinses in tap water and, finally, distilled water.
I In addition to the samples collected for chemical analysis, engineering samples may also be
collected from the HSA borings using standard protocols. These samples would be collected and
I submitted to a soils testing laboratory to further characteize subsurface conditions (e. g.,
Ir- permeability measurements to determine the integrity of any confining beds that may limit the
- migration of any contamination).I
Once sampling is completed, all HDPs will be backfilled with bentonite using a gravity-feed
I method from the surface. HSA borings will be properly abandoned by a State-licensed well
I driller once it has been determined that no more ground water observations or sampling from the
wells is required.
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3.2 Laboratory Analysis
I Generally, analytical procedures will follow the methods described in the QA/QC Plan
I (Appendix B). Soil and ground water samples will be analyzcd by EPA Method 8260 (or
I equivalent) for the following (total) volatile organic compounds:
perchloroethylene (P CE)
and the possible degradation products:
trichloroethylene (TCE)
1, 1 dichloroethylene (1, I -DCE)
cis- 1,2 dichloroethylene (c- I ,}-DCE)
trans- 1,2 dichloroethylene (t- I ,2-DCE)
1,1 dichloroethane ( 1,l-DCA)
1,2 dichloroethane ( 1,2-DCA)
chloroethane
vinyl chloride
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JBR ENvInoNMENTAL CoNSULTANTS, INC.
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LauNoRy Supply CoupaNy SrrE INVESTTGATToN Pr-aN
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Soil samples that may qualify as hazardous waste based on the analytes listed above will be
analyzed by Method 8260 (or equivalent) after Toxicity Characteristic Leaching Procedure
digestion. These analyses would investigate the hazardous nature of the soils under Resource
Conservation and Recovery Act criteria.
4.0 REPORTTNG
Within 60 days of completing the site investigation activities, Laundry Supply will submit a
Report of Investigation to the DSHW. This report will include the results of all work completed
pursuant to the Stipulation and Consent Agreement, all analytical data and interpretations, and
appropriate recommendations.
5.0 SCHEDULE
As per the Stipulation and Consent Agreement, Laundry Supply will begin implementing this
Site Investigation Plan within 60 days of State approval. The DSHW will be notified at least
seven days in advance of the commencement of field activities. The following time line outlines
the expected schedule:
Week 1:
Week 2:
Week 3:
Week 4:
Week 5-7:
Week 8:
Prepare for field work, schedule subcontractors.
Complete drilling of soil borings and sampling of soils and ground water.
Compilation and review of field results.
Receive laboratory results. Further data compilation and review.
Complete Report of Investigation.
Submit completed Report of Investigation to the DSHW.
6.0 REFERENCES
Dragun, J., 1988. The Soil Chemistry of Hazardous Materials, The Hazardous Materials Control
Research Institute, Silver Spring, Maryland.
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JBR ENvInoNMENTAL CoNSULTANTS, [NC.
LauNnRY SUPPLY CoupaNY SITE INVESTIGATIoN PIaN
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STEEL PROTECIOR PIPE
LOCKING PVC CAP
VAR IES BLANK PVC THREADED WELL CASING
SCH 40, 2INCH DIA.
- NEAT PORT L AND CEMENT, TYPE tr
BENTON II E PE LL E T S
2'-1-
5 g
SAND FILTER PACK
VAR IE S
O.OI- SLOTTED
CASING SCH
PVC THREADED WELL
40. 2INCH DIA.
PVC SCREW-ON CAP
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LAUNDRY SUPPLY COMPANY
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BilL, ,\1 31 /9 /
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APPENDIXA
Health and Safety Plan
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STTE HEALTH AND SAF'ETY PLAN
FOR
LATJNDRY SUPPLY CON{PANY PROJECT
SALT LAKE CTTY, UTAH
Prepared for:
Parsons Behle & Latimer
20I South Main Street
Salr Lake city, uT 84111
Prepared by:
JBR Environmental Consultants, lnc.
8160 South Highland Drive, Suite A-4
Sandy, IJT 84093
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.luly, ll.1991
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TABLE OF CONTENTS
1,0 INTRODUCTION...
1. 1 Scope and Applicability of the Site Health and Safety Plan
1.2 Site History' 1.3 Site Description
1.4 Visitors and Subcontractors
20 KEY PERSONNEL
2 .1 Key Personnel
2.2 Site Specific Health and Safety
2.3 Organizational Responsibility
Personnel
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3.0 TASK/OPERATION SAFETY AND HEALTH RISK ANALYSIS
3.1 Scope
3.2 Site Hazards Evaluation
3.2.I Chemical Hazards
3.2.2 General Site Hazards
3.2.2.1 Noise
3.2.2.2 Vehicles
3.2.2.3 Electrical
3.2.2.4 Slips, Trips, and Falls
3.2.2.5 Open Excavations .
3.2.2.6 Utilities
3.2.2.7 Heat and Cold Stress . . .
3.3 General Hazard Control Measures
4.0 PERSONNEL TRAINING REQUIREMENTS
4.I Pre-assignment and Annual Refresher Training
4.2 Site Supervisor Training
4.3 Training and Debriefing Topics
5 O PERSONAL PROTECTIVE EQTJIPMENT TO BE
5. 1 Levels of Protection
5.2 Specific Levels of Protection Planned for the
5 .3 Reassessrnent of Protection Program
5.4 Inspection of Personal Protective Clothing
TJSED
S ite
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IBIt IINVIRONMIrNTAL CONSULTAN'tS. INC
I-n []NDItY.StJPPI-Y COMI)ANy IIEA[-'fl-l AND SAI;lr'l'Y PI.n N
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60 MEDICAL SURVEILLANCE REQTJTREMENTS
6.1 Baseline or Pre-employment Monitoring
6.2 Periodic Monitoring
6.3 Site Specific Medical Monitoring
6.4 Exposure/Injury/Medical Support
6.5 Exit Physical
7.0 FREQUENCY AND TYPE OF AIR MONTTOruNG
8 O SITE CONTROL MEAST]RES
8. 1 Buddy System
8.2 Site Communications PIan
8.3 Work Area Definitiorr
8.4 Nearest Medical Assistance
8.5 Safe Work Practices
8.6 Fugitive Dust Control
90 DtrCONTAMINATION PLAN
9 .l Standard Operating Procedures
9.2 Levels of Decontamination Protection Required
9.3 Equipment Decontamination
EMERGENCY RESPONSE/CONTINGENCY PLAN
10. 1 Pre-Emergency Planning
L0.2 Personnel Roles and Lines of Authority
10.3 Emergency Recognitior/Prevention
L0.4 Evacuation Routes/Procedures . .
10.5 Emergency Contact/Notification System
10.6 Emergency Medical Treatment Procedures
L0.7 Fire or Explosion
10.8 Spill or Leaks
10.9 Emergency Equipment/Facilities
SPILL CONTAINMENT PROGRAM
100
for Personnel
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.lllR IlNVIRONMEN]'AL CONSLJ[-'fAN'l-S, IN('
I.,^ I INI)I1Y .STJPPI-Y COMPANY IIIIAI-1-I I NNI) .SAITI..'I'Y I)I-AN
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LIST OF TABLES, F[GTJRES, AND ATTACHMENTS
Table 3- 1
Table 4-L
Table 5-1
Table 8- 1
Table 10- 1
Table'10-2
Parameters for Chemical Contaminants of Concern
Training Topics and Frequency of Presentation
Specific kvels of Protection Planned for the Task
Hand Signals
Emergency Recognition/Control Measures
Emergency Telephone Numbers
Assignmeni,
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Figure 1 Site Map
Figure 2 Organizational
Figure 3 Map Depicting
Cfru.t....... .......
Route to Nearest Medical Facilities
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Attachment 1: Heat and Cold Stress
Attachment 2: PPE Inspection Checklist for Clothing, Gloves and Boots
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I BII EN V IRONM IrNTn t- CONS Lj LTA N'rS.
I-ATJNDRY SI.JPPI-Y (-OM PANY I_II]AI- I{
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1.0 INTRODUCTION
1.1 Scope and Applicability of the Site Health and Safety Plan
This Health and Safety Plan (HASP) has been prepared by JBR Environmental Consultants,
Inc. (JBR) to present the safety procedures to be implemented while performing work at the
Laundry Supply Company site investigation project located at 3785 West 1987 South in Salt
Iake City. This HASP only applies to JBR employees. The project will include soil boring,
installation of monitor wells, and soil and ground water sampling from the property which has
been impacted by a release of perchloroethylene (PCE) from the former underground storage
tank (UST) system. This site will not have any permit-required confined spaces under presenr
project plans.
The personal health and safety of all individuals directly involved in the project and of the
general public near the site is irnportant. Therefbre, all prudent and reasonable measures will
be taken to establish and maintain safe and healthy working conditions.
This HASP identifies the (1) potential hazards associated rvith working with tlie soils and
ground water anticipated to be impacted by PCE, and, (2) actions which will be taken to
minimize or eliminate those hazards; e. 9., engineering controls, use of personal protective
equipment, training, etc. Although every effort was made to develop a plan that is as
comprehensive and detailed as possible, conditions may change once the project is initiated
which may warrant modifications to this plan.
JBR employees on site shall be informed of the site emergency response procedures and any
potential fire, explosion, health, or safety hazards of the project. This HASP summarizes the
chemical hazards in Table 3-1 and defines protective measures planned for during the field
testing.
During development of this plan, consideration was given to current safety standards as
defined by EPA/OSHA/NIOSH, health effects and standards for the known contaminants, and
procedures designed to account for the potential for exposure to unknown substances.
Specifically, the following reference sources have been consulted:
OSHA general industry standards (29 CFR 1910) and construction industry
standards (29 CFR 1926).
NIOSH Pocket Guide to Chemical Hazards, June 1994.
1994-1995 Threshold Lirnit Values fbr Chemical Substances and Ph1,5ig.1
Agents and Biological Exposure Indices, ACGIH, Cincinnati, Ohio.
OSHA/NIOSH/USCG Occupational Saf'ety and Health Guidance Manual fbr
[-lazardous Waste Site Activities. 1985.
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l-n tJNI)liY St,ll']l'}t-Y ('OMPANY I']ROJIIC'[ llEn l-l'lln NI) Sn FIr'l'Y PI-n N
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1.2 Site History
The property is owned by Laundry Supply Company, a distributor of laundry and dry
products, which previously operated a UST system on the site to store PCE prior to
distribution. As a result of the closure of the two 10,000-gallon USTs in April 1996,
ground water were determined to be impacted by a release of PCE.
1.3 Site Description
cleaning
soils and
The property is located at 3785 West 1987 South in a business/light industry park on the west
side of Salt Lake City. A map of the area is included as Figure 1. The site is comprised of
approximately 1 .77 acres that includes asphalt parking areas and one building operated as a
warehouse, offlce, and garage.
1.4 Visitors and Subcontractors
Visitors and subcontractors entering the work area will have the option to read and adopt the
provisions of this HASP. Such visitors and subcontractors will be expected to comply with
relevant OSHA requirements such as medical monitoring (Section 6.0), training (Section 4.0),
and respiratory protection (Section 5.0). Visitors and subcontractors will be expected to
provide their own protective equipment.
IBIt I:NVIIIONMEN'fn L CONSUT-'l'ANTS INC
l-AtlNDllY SUI)l)l.Y (IOMI'}ANY PIi(-)JIlCl' IIhAI-'l'll n NI) Sn t:E'l'Y I'l.n NI
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2.0 KEY PERSONNEL
In order to properly administer the HASP's requirernents, the identification and assignment of
responsibilities to key individuals is essential for the development, coordination and
implementation of the plan. The organization structure identifies those individuals and
establishes the chain-of-command to effectively implement the plan through an integrated
effort.
2.1 Key Personnel
The personnel and organizations that are critical to the planned activities at the site area can be
I founO in Figure 2. This organizational chart will be reviewed and updated as necessary.
2.2 Site Specific Health and Safety Personnel
Health and Safery Officer (HSO)- The HSO is responsible for preparing this HASP.
Changing field conditions may require decisions to be made concernin-q adequate protection
programs. Therefore, it is vital that personnel assigned as HSO be experienced and meet the
training requirements specified by OSHA in 29 CFR 1910.120 (see Section 4.0 of this HASP).
The HSO is the only individual who can modify this HASP.
Site Safety Officer (SSO) - The SSO will be the on-site representative of the HSO. The SSO
has the responsibility for ensuring implementation of the HASP, and any other site specific
health and safety guidance developed by the HSO. The SSO will maintain close liaison with
the HSO. Any unusual circumstances shall be brought to the immediate attention of the HSO.
The SSO shall have hazardous waste site experience and training in health and safety, and
meet the HAZWOPER training requirements found in 29 CFR 1910.120, paragraph e(3).
2.3 Organizational Responsibility
Project Manager (PM) - The Project Manager is responsible for overall project administration
and contractor oversight. As a part of that oversight function, the Project Manager will ensure
that all project plans meet both JBR and Laundry Supply Company policies, and that the health
and safety of all site personnel is the primary concern.
Site Supervisor (SS) - The Site Supervisor is responsible for daily activities at the site and will
act as the SSO. The Site Supervisor will be on-site during all investigation activities.
Field Personn.el (FP) - Field Personnel are responsible fbr perfbrming their work saf'ely and
fbllowing the guidance found in this HASP. Any unsaf'e conditions must be brought to the
irlmediate attention of the Site Supervisor.
,BR ITNVIRONMEN-|AL CONSUI-'fANl-S INCI.
l-AtJNI)ltY SUI'}PI-Y ('OMPANY PltO.lllcl'IllrAI-I'll ANI) Sn trl:'l'Y l'}l-n N
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I 3.0 TA'K/'PERATI'N SAFETY AND HEALTH RISK ANALYSIS
I 3.1 Scope
I I'lazards are similar for most types of hazardous waste-related investigations. These hazards
I include, but are not Iimited to, heavy equipment (including drilling equipment), electrical,
I open excavations, overhead obstructions, slips/trips, and the chemicals being remediated at the
site. These hazards are discussed below.
t 3.2.L Chernicat Hazards
I This HASP identifies the hazards associated with the anticipated occurrence of PCE and
I related degradation products at the site identified as the Laundry Supply Company project. It
also identifies the methods needed to protect personnel from those hazards. Table 3-l
I provides a summary of the chemical hazards associated with this site.
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3.2 Site Hazards Evaluation
Perchloroethylene (PCE) is classified as a Group 28 carcinogen by the IARC. PCE is an
I apparent liver carcinogen in mice. It is harmful if digested, inhaled, or absorbed dermallyr The vapor pressure of PCE is 14 mm Hg at 20'C. Exposure by inhalation may cause
irritation to the mucous membranes and upper respiratory tract. Dermal contact may result in
I skin or eye irritation. Acute inhalation exposure to PCE causes a narcotic effect resulting in
I nausea, dizziness, and headaches. Prolonged overexposure may result in damage to the liver
r and kidneys. The Utah OSHA permissible exposure limit and ACGIH TLV-TWA are 25
I ppm. PCE concentrations in two ground water samples collected from the site were reported
at22,000 and 180,000 mg/l. PCE concentrations in four soil samples taken from the site
r ransed from (2.0 (non-detect) to 11,000 mg/kg.
IO
Trichloroethylene
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Perchloroeth),lene (fetrachloroethlt[sne)
Trichloroethylene (TCE) is classified as a Group 3 carcinogen by the IARC. It is harmful if
inhaled, digested, or absorbed dermally. Dermal exposure results in skin and eye irritation.
The vapor pressure of TCE is 58.7 rum Hg at 20 "C. Inhalation affects the mucous
membranes and upper respiratory tract. Ingestion may result in the irritation of mucous
membranes and in gastrointestinal disturbances. Acute inhalation exposure to TCE causes a
narcotic eff'ect resulting in nausea, dizziness, and headaches. Prolonged overexposure may
result in damage to the liver and kidneys. 'l-he Utah OSI{A perniissible exposure Iinrit and the
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ACGIH TLV-TWA are 50 ppm. TCE may be present on site as a degradation product of
PCE.
1,2 Dichloroethane
1,2 Dichloroethane (EDC) is classified as a Group 28 carcinogenby the IARC. EDC is
rumorigenic in rodents and is harmful if digested, inhaled, or absorbed dermally. Skin
absorption is considered a significant route of entry. Dermal exposure results in skin and eye
irritation, moderate edema, and necrosis. Ingestion may result in irritation of the mucous
membranes and gastrointestinal disturbances. The vapor pressure of EDC is 63.7 mm Hg at
20'C. Acute inhalation exposure to EDC causes headaches, lethargia, circulatory weakness,
pulmonary ederna, and kidney and liver damage. Prolonged over-exposure to the chemical
may result in epigastric pain, irritation of mucous membranes, neurological changes, and liver
and kidney impairment. The Utah OSHA permissible exposure limit and the ACGIH TLV-
TWA are 10 ppm. EDC is possibly on site as a degradation product of PCE.
Vinyl Chloride
Vinyl chloride is classified as a Group I carcinogen by the IARC. It is tumorigenic in man
and is harmful if digested, inhaled, and absorbed derrnally. However, absorption through the
skin is considered minor. Vinyl chloride vapors can cause eye irritation. The vapor pressure
of vinyl chloride is 2300 mm Hg at20oC. Acute inhalation exposure to vinyl chloride causes
lightheadedness, dizziness, nausea, dulling of vision, and depression of the central nervous
system. Prolonged overexposure to the chemical may result in damage to the liver, blood, and
respiratory systems. The Utah OSHA permissible exposure limit is 1 ppm and the ACGIH
TLV-TWA is 5 ppm. Vinyl chloride is possibly on site as a degradation product of PCE.
3.2.2 General Site Hazards
3.2.2.1 Noise
Employees may encounter elevated noise levels because of heavy and portable equipment on
the site. The general rule of thumb to determine if an employee is being exposed to excessive
noise is if two workers must shout to communicate at a distance of approximately three feet.
Hearing protection is encouraged for all equipment operators.
J llll EN V I IION M IrN'rA L ('ON.S tl I-'[,4 N'f S I NC.
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I 3.z.z.z vehicles
I There will be different types of vehicles used on the site. These include heavy equipmenr,
I drilling equipment, and support vehicles. Special awareness training will be given to the field
personnel to minimize vehicle hazards as needed.
I 3.2.2..3 Etectrical
I Electricity represents ahazard on the site. Water, high voltages, and extension cords increaser the hazards of electrical shock to workers. To reduce this hazard, the SSO will become aware
of the locations of these hazards before beginning work on the site.
t 3.2.2.4 slips, Trips, and Fatts
t The use of water and equipment in the work area increases the opportunity fbr slips, trips, ancl
falls. To reduce these hazards, field personnel will be encouraged to keep the rvork area clean
I with good housekeeping. Water will be minimized on walking surfaces. Field personnel will
t be properly advised of these hazards.
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3.2.2.5 Open Excavations
No excavations are currently planned for the investigation but may be included with a later
phase of work. Work in and around any excavations will be guided by relevant OSHA
regulations. If utilized, excavating will be limited to specific work areas. However,
excayations may remain open temporarily for a variety of reasons. Workers should avoid such
excavations as necessary. Temporary fencing will not be required around excavations
provided they are not left open over night. Pits and trenches left open over night or over
weekends will require marking with hazard tape for short-term safety. If excavations will
remain open and unattended for longer periods of time, a temporary fence will be installed for
security and safety reasons.
3.2.2.6 Utilities
Buried utilities will be identified and rnarked by public and/or private utility locators.
Overhead telephone and electric lines are present on the property and should be avoided by
equipment operators.
3.2.2.7 Heat and Cold Stress
See Attachment 1.
3.3 General Hazard Control Measures
General hazard control measures can be maintained by the following:
Thorough application of the work plans and HASP procedures.
No initial work activity will commence without reviewing the work plan and the
HASP, or when any questions arise regarding the HASP requirements.
A site safety meeting will be held at the beginning of the investigation activities
and when any hazardous situation arises not adequately addressed by the HASP.
Common sense practices in hazard avoidance (i.e., avoid walking needlessly
through puddles, leaning on or sitting on equipment, etc.).
Be alert for and heed all information and warning signs at all times.
Practice proper hygiene habits (i.e., cleaning up prior to eating and after
working at the site using an appropriate cleaning solution).
Be alert to potentially hazardous situations that may arise (i.e., strong irritating
odors, visible vapor clouds and dust, unusual conditions and suspicious
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I-AIJNI)RY StJI'I)I-Y ('OMPANY PROJEC'f IIEAI-'fII ANI) SAITE-I'Y PI-AN I0
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substances, stability of stacked items, condition of site structures and equipment
being used, etc.).
Practice good housekeeping habits (i.e., keep traffic and work areas free of
debris or obstacles, dispose of all trash properly, keep tools properly stored
when not in use, keep supplies properly stored, and patrol the area prior to the
end of the workday).
Misuse of tools and equipment or circumventing safety devices can result in
injury to yourself and/or others. Do not use make-shift tools or equipment to
perform your job. Keep all machinery guards, guard rails, and other protective
devices in place and in good operating order. Use only properly functionin-q
tools and equipment.
Promptly report all occupational injuries/illnesses, unsaf-e and unhealthy
practices, and conditions to the SSO.
Follow 29 CFR 1910.1200 labeling requirements to reduCe potential exposures
to chemicals used on-site as cleaning agents or other purposes.
Follow appropriate fire protection requirements and fire prevention practices.
4.0 PERSONNEL TRAINING REQUIRtrMENTS
Appropriate training of workers will be required
potential hazards associated with the work and to
expectations. These training requirements apply
area(s).
to ensure that personnel are informed of the
ensure that the quality of the work meets
only to personnel that will enter the work
Consistent with OSHA's 29 CFR 1910.L20 regulation covering Hazardous Waste Operations
and Emergency Response, site personnel are required to be trained in accordance with the
standard. At a minimum, they are required to be trained to recognize the hazards on-site, the
provisions of this HASP, and the responsible personnel.
4.1 Pre-assignment and Annual Refresher Training
Prior to arrival on-site, JBR will be responsible for certifying that JBR employees meet the
requirements of pre-assignment training. Consistent with OSHA 29 CFR 19i0.120 paragraph
(eX3), and where appropriate, each employee should be able to provide a document certifying
dates of 40 hours of training and 3 days of actual field experience under the direct supervision
of a trained, experienced supervisor for general site workers. Personnel must receive eight
hours of annual refresher training in accordance with 29 CFR 1910.120, para_eraph e(8).
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LALINDITY SL,PPLY COMPANY PROJtlc'l- llEn l--l'll n NI) Sn Ftll'Y Pl-AN
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4.2 Site Supervisor Training
I Consistent with OSHA 29 CFR lgl|.Lz|paragraph (e)(4), individuals designated as Site
Supervisors require an additional eight hours of training.I Table 4-1 Training Topics and Frequency of Presentation
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rEfsiiiing I-.r,EqU.enc,y
Air monitoring Pre-ent rr
Drum and container handling Pre-entry
Enrergency response Pre-ent r\
HAZWOPER Pre-entrv
Heavy machinery Pre-entry
Medical surveillance Pre-entry
Respiratory protection Pre-entry
Training requirements Pre-entry
Chemi cal hazards (Table 3. 1)Pre-entry
Engineering controls and work practices Pre-entry
General health and safety Pre-entry
Personal protective equipment Pre-entry
Task Hazards Pre-Entry
S ite control Pre-ent11
I JBR ENVIR.NMENTAI- C.NSULTANTS INC.
LAUNI)RY SLJI']PLY COMPANY PROJEC-| IIlrn l-1'll AND .Sn IrE'l-Y PI-n N
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4.3 Training and Debriefing Topics
The SSO will discuss those topics found in Table 4-1 with the Field Personnel prior to
commencement of, or change in, site tasks. Site training will be documented by noting
topic(s) and attendants.
5.0 PERSONAL PROTECTIVE EQUIPMENT TO BE USED
Personal protective equipment will be used to reduce the potential for workers to be exposed
to chemical or physical hazards that may be encountered on the site. This section describes
the standard work attire that will be used during the site remediation and defines the criteria
established for upgrading to more protective PPE.
5.1 Levels of Protection
Personnel wear protective equipment when activities involve hazardous concentrations of
known or suspected atmospheric contamination, when hazardous concentrations of vapors,
gases, or particulates may be generated by site activities, or when direct contact with skin-
affecting substances may occur. Full-face piece respirators protect lungs, gastrointestinal
tract, and eyes against airborne toxins. Chemical-resistant clothing protects the skin from
contact with skin-destructive and absorbable chemicals.
The specific levels of protection and necessary components for each have been divided into
four categories according to the degrees of protection afforded. Guidelines for selecting the
appropriate PPE for each level of protection listed below can be found in 29 CFR 1910.L20,
Appendix B, General Description and Discussion of the lrvels of Protection and Protective
Gear.
I Level A:
Level B:
Level C:
Level D:
Should be worn when the highest level of respiratory, skin, and eye protection is
needed.
Should be worn when the highest level of respiratory protection is needed, but a
lesser level of skin protection. Level B is the primary level of choice when
encountering totally unknown environments.
Should be worn when the criteria for using air-purifying respirators are met, and a
lesser level of skin protection is needed.
Should be worn only as a work uniform and not in any area with respiratory or skin
hazards. It provides minimal protection against chemical hazards.
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I-AUNDRY SUPPLY COMI'}ANY PROJECT HIrA[-]'H n ND Sn FE'I'Y Pl-AN l3
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Modifications of these levels are permitted, and routinely employed during site work activities
to maximize efficiency. For example, [rvel C respiratory protection and [rvel D skin
protection may be required for a given task. Likewise the type of chemical protective
ensemble (i.e., material, format) will depend upon contaminants and degrees of contact. The
level of protection is based upon the following:
Type and measured concentration of the chemical substance in the ambient
atmosphere and its toxicity.
Potential for exposure to substances in air, splashes of liquids, or other direct
contact with material due to work being done.
Knowledge of chemicals on-site along with properties such as toxicity. route of
exposure, and contaminant matrix.
In situations where the type of chemical, concentration, and possibilities of contact are not
known, the appropriate level of protection must be selected based on professional experience
and judgment until the hazards can be better identified.
5.2 Specific Levels of Protection Planned for the Site
Table 5-l lists the specific level of protection for workers at this site. PPE requirements and
choice of materials are also identified.
5.3 Reassessment of Protection Program
The level of protection provided by PPE selection shall be upgraded or downgraded based
upon a change in site conditions, findings, or investigations. When a significant change
occurs, the hazards should be reassessed. Some indicators of the need for reassessment are:
Commencement of a new work phase, such as the start of sampling or work that
begins on a different portion of the site.
Change in job tasks during a work phase.
Change of season/weather.
When temperatures or individual medical considerations limit the effectiveness
of PPE.
Contaminants other than those previously identified are encountered.
Change in ambient levels of contaminants.
Change in work scope which aff-ects the degree of contact with contaminants.
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.IBI{ ENVIRONMEN-|AI- CONSULTANTS INC.
LAUNDRY SUPPLY COMPANY PROJEC'f I{EN I-'[H ANt) .SAFETY I'LAN t4
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Table 5-l Specific Levels of Protection Planned for the Task Assignments
Soil boring and well
installation
Level D
Coveralls
Gloves
Boots
Safety glasses
Hard hat
Cotton
Leather
Steel-toed
Standard
Standard
Soil and ground water
sampling
Level D
Coveralls
Gloves
Boots
Safety glasses
Hard hat
Cotton
Leather (no liquid contacr)
Nitrile (liquid conracr)
Steel-toed
Standard
Standard
Industrial hygiene
monitoring, if performed
Level D
Coveralls
Boots
Safety glasses
Hard hat
Cotton
Steel-toed
Standard
Standard
I A half-face respirator with HEPA/organic cartridges will be available during the soil boring and
I well installation activities.
I 5.4 Inspection of Personal Protective Clothing
Proper inspection of PPE features several sequences of inspection depending upon specific articles
I of PPE and its frequency of use. The different levels of inspection are as follows:r Inspection and operational testing of equipment received from the factory or distributor.
Inspection of equipment as it is issued to workers.I
: : lrffirl:ffi,:T;i,'#:;"3,1?lJJ;:r '[o
main'[enance
f . Periodic inspection when a question arises concerning the appropriateness of the
selected equipment, or when problems with similar equipment arise.
t If PPE is required because of a reevaluation of the site hazards, its primary inspection will
occur immediately prior to use and will be conducted by the user. This ensures that the
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JBR ENVIRONMENTAL CONSULTANl'S INC
I-ATJNDRY SUPPLY COMPANY PROJECT I-IEALTI{ AND SN ITE'|Y PI-ANI
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Medical monitoring programs are designated to track the physical condition olemployees on a
I regular basis as well as document pre-employment or baseline conditions prior to potentiatr exposures. The medical surveillance program is a part of each employer's health and saf'ety
I :t;-",i'e or pre-enrptoynrent i\{o,itori,g
Prior to being assigned to a hazardous or a potentially hazardous activity involving exposure to
toxic materials, each employee must receive a baseline or pre-etllployment physical. It should
categorize employees as fit-for-duty and able to wear respiratory protection. The contents of
the physical is to be determined by the ernployer's medical consultant. As suggested by
NIOSH/OSHA/USCG/EPA's Occupational Safety & Health Guidance Manual for Hazardous
Waste Site Activities and 29 CFR 19L0.120, the minimum medical monitoring requirements
for work at this site includes the following:
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specifrc device or article has been checked-out by the user and that the user is familiar with its
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use. See Attachment 2 for the PPE lnspection Checklist For Clothing, Gloves, and Boots.
I 6.0 MEDICAL SURvEILLANCE REQUIREMENTS
. Complete medical and work history. Physical examination. Pulmonary function tests (FVC and FEVI). Chest X_ray. EKG. Eye examination and visual acuity. Audiometry. Urinalysis. Blood chemistry, including hematology, serum analyses, and blood lead levels
6.2 Periodic Monitoring
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ln addition to the baseline or pre-employment physical, all ernployees require a periodic
physical within the last twelve months unless the advising physician believes a shorter interval
is appropriate. The employer's medical consultant should prescribe an adequate physical
which fulfills OSHA 29 CFR 1910.120 requirements. The baseline or pre-en.rployment
physical outlined in Section 6.1 rnay be applicable.
t J,* rlNVr*oNMEN'rn r- croNSrJr-'r-AN'r's rN('.r I-n tJNI)RY SUI)l']l.Y (IOMI)n NY PItOJIlC'l' Ill:z\l.l'll n NI) Sn I'll'l'Y I'l.n N
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AII personnel working in contaminated or potentially contaminated areas at this site will verify
t currency (within twelve months) with respect to medical monitoring. This is done by
I providing written documentation from the examining physician stating the date of the exam, a
statement that the worker is qualified to work onahazardous waste site, and the worker is
I medically qualified to wear the level of PPE required for the site.
I As a follow-up to an injury or possible exposure above established exposure limits, allr employees are entitled to and encouraged to seek medical attention and physical testing.
r Depending upon the type of exposure, it is critical to perform follow-up testing within 2448
I hours. It will be up to the employer's medical consultant to advise the type of test required to
accurately monitor for exposure effects.
T 7.0 FREQUENCY AND TYPE oF ATR MONITORING
Ir Chemical hazards for this site were identified from client-supplied information, results of
I sampling, and interviews available to JBR. Task hazards have been determined based on the
t planned scope of rvork. In neither case, were either the types of hazards or expected doses
sufficient to warrant additional medical monitoring beyond current baseline and annual
I physicals for hazardous waste site workers. Therefore, for activities at this site, no site
f specific tests beyond those found in Section 6.1 will be required prior tb individuals entering
the work area.
I 6.4 Exposure/Injury/Medical Support
I 6.5 Exit Physical
I At termination of employment or permanent reassignment to an activity or location which does
I not represent a risk of exposure to hazardous substances, JBR may request the employee take
an exit physical. If his/her last physical was within the last six months, the advising medical
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consultant can use that physical exam as the exiting physical.
r The purpose of air monitoring is to identify and quantify airborne contaminants in order to
I verify and determine the level of worker protection needed. Initial screening for identification
- is often qualitative, i.€., the contaminant, or the class to which it belongs, is demonstrated to
r be present but the determination of its concentration (quantification) must await subsequentI
i7t JBrt ENVTR.NMENTAT- ..NSTJLTANT' rNC.
LAUNDItY SLJPPI-Y COMPANY PIIOJECT I{EAI-1-II N ND SAITI]'|Y PI-AN
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testing. Two principal approaches are available for identifying and/or quantifying airborne
t contaminants:
I A direct-reading photo-ionization detector (PID), or equivalent, will be used to monitor total
organic vapor concentrations in the ambient air of the (outdoor) work area. Air sampling will
r not be conducted for this project.I
The OSHA/NIOSH/EPA/USCG Occupational Safety and Health Guidance Manual for
I Hazardous Waste Site Activities provides an overview of available monitoring/sampling
I instrurnentation for on-site use and their specific application. For the specific instrument to be
used, calibration of the instrument is to be performed in accordance with the instrument's
t calibration procedures.
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For our specific tasks, a direct-reading PID will be used to measure exposures to organic
I vapors. Based on the available information and the contaminants expected to be present at ther site, a PID reading of 5 ppm or greater (above background) in the breathing zone (point of
I inhalation) will indicate that the half-face respirator with appropriate combination
f HEPA/organic vapor cartridges must be worn. A reading of 10 ppm or greater (above
background) will require a re-evaluation of the work plan and a temporary work stoppage until
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the situation can be evaluated.
t 8.0 srTE coNTRoL MEASURES
8.f Buddy System
I The implementation of a buddy system is required when conditions present a risk to personnel.
r A buddy system requires at least two people who work as a team; each looking out for each
I c other. Work activities on this site will be done under a buddy system once organic vapor:- concentrations are sufficient to require the half-face respirator. Sampling will not require a
r buddv-I
The following section defines measures and procedures for maintaining site control. Site
I control is an essential component in the implementation of the site health and safety program.I
I JBR ENVTR.NMaNTAL croNSUr-TANTS rNC.
t-AtiNDRY StJPPI-Y COMI'}ANY PROJEC'I- IIEAl-'fll n ND SAFII'rY PLAN
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I 8.2 Site Communications PIan
I Table 8-1 lists the hand signals that will be used for communications during activities at the
I site when "face to face" and telephone communications are difficult or not possible.
I 8.3 Work Area Definition
The work area around the drill rig will be defined by hazard tape and/or items such as
I barricades or traffic cones. The definition of formal work zones (exclusion, contaminantr reduction, etc.) will not be required during this site characterization phase of the project.
Table 8-1 Hand Signals
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8.4 Nearest Medical Assistance
. No snroking., eatirrg. or drinking in this zone.
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Figure 3 provides a map of the route to the nearest medical facility which can provide
I em"ergency care for individuals who may experience an injury or exposure on-site. The route! to the hospital has been verified by the SSO and should be familiar to all site personnel.
I 8.5 Safe Work Practices
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Safety requirements for performing work in the work area include:
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,Signals
Hands clutchins throat Out of airlcannot breath
Hands on top of head Needs assistance
Thumbs up OK/ I am all right/ I understand
Thumbs down No/ Negative
Arms waving upright Send backup support
Grip partners wrist Exit area immediately
JBR ENVIRONM ENTAL CONSULTANI'S INC.
I I.A(.JNDRY SUPPI-Y COMPANY PROJEC'I'I{EAI,'I-II ANI) SAI;II Y I-,I-N NI
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. No horse play.
. No matches or lighters in this zone.
. Implement the communications system.
. Line of sight must be in.position.
. Wear the appropriate level of protection as defined in the Health and Safety
Plan.
' Vehicles will observe a maximum speed limit of 15 miles per hour on the site.
No fugitive dust is expected to result from the anticipated on-site activities.
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e.0 DECONTAMTNATTON PLAN
9.1 Standard Operating Procedures
I Decontamination involves the orderly and controlled removal of contaminants. All site
I personnel should minimize contact with contaminants in order to minimize the need for
I extensive decon. The SSO, with advice from the HSO, will establish decontamination
procedures that meet the intent of the Occupational Safety and Health Guidance Manual for
- Hazardous Waste Site Activities, Section 10 and Appendix D.I
The following general procedures will be used on this site:
. Used PPE articles should be placed in appropriate receptacles for recycle or
disposal.. Personnel should be familiar with proper decontamination techniques (i.e.,
removing PPE clothing in an inside out manner).. Before exiting the regulated work area. personnel must have removed all
protective clothing and gear, then they must have washed their hands and facial
areas with soap and water (the practice of proper hygiene habits). Alternatively,
disposable moist towelettes may be used to rninimize the volumes of waste
water generated"
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I 8.6 Fugitive Dust Control
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Table 5-1 lists the tasks and specific levels of protection required for each task. Personal
protective equipment used during decontamination will be consistent with these specific levels.
However, it is not anticipated that extensive decontamination will be required. If the SSO or
HSO determine site activities are more hazardous than anticipated, then this plan will be
amended.
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., I]R ENVIRONMENTA I- CONSLJI-'TA N'IS I NC].
I LAt,NDRY STJPPI-Y ('OMl'n NY l']RO.llr(l'f I'ltin l.l'll r\NI) .SAITE'lY I)l.n NI
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I 9.2 Levels of Decontamination Protection Required for Personnel
I The levels of protection required for any personnel assisting with decontamination will be the
I same as that required in the work area, The SSO is responsible for monitoring
decontamination procedures and determining their effectiveness.
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9.3 Equipment Decontamination
All equipment and personnel working in the work area that come in contact with soil and
ground water will be decontaminated before leaving the work area. Decontamination facilities
will include a high pressure sprayer for use on heavy equipment. Heavy equipment will be
decontaminated at the end of the project by brushing, scraping, or use of the high pressure
sprayer on equipment that has come in contact with contaminated media. All waste water will
be collected in drums and stored on site pending the selection of an appropriare disposal
optlon.
All disposable protective clothing, plastic sheeting, or other materials that have come in
contact with contaminated media shall be containerized and disposed of properly. Equipment
and solvents used for decontamination shall be decontaminated or disposed of properly.
Cotton coveralls shall be laundered when necessary at a comntercial laundr1,. Commercial
laundries or cleaning establishments that decontaminate protective clothing or equiplnent shall
be inforrned of the potentially harmful effects of exposures.
1O.O EMERGENCY RESPONSEiCONTINGENCY PLAN
This section describes contingencies and emergency planning procedures to be implemented at
the site. To the best of knowledge, this plan is compatible with local, state and federal
disaster and emergency management plans as appropriate.
I t0.r Pre-Emergency Planning
I During the initial health and safety meeting, all employees will be trained in, and reminded of,
I provisions of the emergency response plan, communications systems, and evacuation routes as
warranted. This plan may be periodically reviewed by the SSO and revised if necessary by the
HSO. This would ensure that this plan is adequate and consistent with prevailing site
conditions.
10.2 Personnel Roles and Lines of Authority
The Site Supervisor has primary responsibility for responding to, and correctins, emergency
situations. This includes taking appropriate rneasures to ensure the safety of site personnel and
the public. Although unlikely, possible actions may involve evacuation of personnel from the
site area. He/she is additionally responsible fbr ensuring that corrective measures have been
implemented and appropriate authorities notified.
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I 10.3 Emergency Recognition/Prevention
I Table 3-1 and Section 3.3 provide listings of on-site chemical and task hazards, respectively.
I Additional hazards as a direct result of site activities are listed in Table 10-1 as are their
prevention and control techniques/mechanisms. Personnel will be familiar with techniques of
I hazard recognition from pre-assignment training and site-specific briefing(s).
I ::;. i- ":::#:H"..essirates an evacuarion orrhe sire, the rorowing
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procedures will be implemented:
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10.5 Emergency Contact/Notification System
Table 10-2 provides names and telephone numbers fbr emergency personnel. In the event of a
I medical emergency, the Site Supervisor will notify the appropriate emergency organization. In
- the event of a fire or spill, the Site Supervisor will notify the appropriate local, state, and
I federal agencies.
I 10.6 Emergency Medical Treatment Procedures
I Any person being transported to a clinic or hospital for treatment should take with themr infbrmation on the chemical(s) they have been exposed to at the site. This information is
included in Table 3-1.
I Any vehicle used to transport contanlinated personnel will be treated and cleane<l as necessary.
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Personnel will be expected to proceed to the closest upwind exit, and proceed to a sat'e
distance (at least 100 feet from the perceived hazard). Personnel will remain at that
area until an authorized individual provides further instructiol.ts.
I Any person who becomes ill or injured in the work area must be decontaminated, as
appropriate. If the injury or illness is minor, decontamination should be completed and first
t aid administered prior to transport. If the patient's condition is serious, at least partial
I decontamination should be completed if additional injury would not be sustained (i.e.,
complete disrobing of the victim and redressing in clean coveralls or wrapping in a blanket).
I First aid can be administered while awaiting an ambulance or paramedics. All injuries and
I illnesses must be immediately reported to the Site Supervisor.
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10.7 Fire or Explosion
In the unlikely event of a fire or explosion, the local tire department should be summoned
immediately. Upon their arrival, the Site Supervisor or designated alternate will advise the
fire commander of the location, nature, and identification of the hazardous materials on-site.
If it is safe to do so, site personnel may:
10.8 Spill
Use fire fighting equipment available on-site to control or extinguish the fire.
Remove/isolate hazardous materials which may contribute to the fire.
or Leaks
In the unlikely
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event of a spill or a leak, JBR personnel will:
lnform the Site Supervisor immediatell,
Don appropriate PPE
Locate the source of the spillage and stop the f'low if it can be done safely
Begin containment and recovery of the spilled materials if it can be done safely
First aid kit
Eye wash
Fire extinguisher
Portable phone
10.9 Emergency Equipment/Facilities
Emergency equipment will be kept inside the JBR vehicle being used to support the site work.
This equipment will consist of the following:
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IBIt ENVI ITONM IrN'l-A L CONStJt.'fANl-S INC
l.r\t.tNDItY SIJPPI-\' ('Ol\41'n NY I'ltOill(l'l' Illln l-'l'll ANI) SAI;l:'l-Y PI.AN )5
Table l0-1 Emergency Recognition/Control Measures
Table l0-2 Emergency Telephone Nurnbers
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Fire/Explosion Fire extinguisher, fire
department
Appropriate work habits
Spills Sorbent materials or shoveling
Berms/dikes and equipment
inspections
Organic vapor
re Iease
Water spray, air monitoring,
evacuation
Periodic PID monitoring,
evacuation routes
:ti{.:.:.:.:.:.:.:.:.:.:.:+:.:.:.:.:'t:a{rrgfluIufltlt
Health and Safety
Officer
Dick Jordan Jr., MS, CIH
JBR Environmental Consultants, lnc.
[phone] work
[phone] home
JBR Environmental
Consultants, Inc.
Bob Bayer
Vice President
[phone] work
[phone] home
Police Dispatch 911
Fire Dispatch 911
911 Dispatch 911
Local hospital Pioneer Valley Hospital
3460 South 4155 West
West Valley City , Utah
(80 r ) 964-3600
Medical emergency
24-hour toxicological
information service
(5 r 3) 421 -3063
CHEMTREC (800) 424-e300
JBlt ENVIRONM IrN-rAl- CONStil-'fAN'rS IN('.
LAtINI)llY .S[]l)l)l-\' ('OMPANY PI{O.ll::("1' lll-.AI- I'll ANI) Sn Ijl:'l'}' l'}l-AN l6
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I1.O SPILL CONTATNMENT PROGRAM
The remediation process will not likely require the use or generation of any hazardous materials
that would warrant significant concern'related to spills. However, the procedures discussed in
this section comprise the spill containment program in place for activities at the site.
The following procedures shall be followed for handling drums and containers of hazardous
materials or waste:
All drums and containers used during the cleanup shall meet the appropriate DOT,
OSHA, and EPA requirements for the waste that they will contain.
Drums and containers shall be inspected and their integrity assured prior to being
moved. Drums or containers that cannot be inspected before being moved because
of storage conditions, shall be positioned in an accessible location and inspected
prior to further handling.
Operations on site will be organized so as to minimize the amount of drunr or
container n'rovement.
Employees involved in the drum or container operations shall be warned of tl"re
hazard associated with the containers.
Where spills, leaks, or ruptures may occur, adequate quantities of spill containment
equipment (e. g., absorbent, pillows, etc.) will be stationed in the immediate area.
The spill containment program must be sufficient to contain and isolate the entire
volume of any hazardous substances being transferred.
Drums or containers that cannot be moved without failure, shall be emptied into
a sound container.
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Attachnrent l: Heat and Cold Stress
1.0 Heat Stress
Heat stress is caused by various factors which include environmental conditions, what a person
wears (including PPE), workload, and even a person's individual characteristics. Susceptibility
to heat stress can vary between individuals depending on factors such as lack of physical
fitnes's, obesity, alcohol and drug use, age, rest and others. Since the occurreflce of heat stress
depends on these factors, all personnel should be monitored.
l.l Heat Stress Monitoring
For individuals wearing perrneable clothing (standard clothes and work clothing),
recorrrmendations for monitoring requirements, including work/rest schedules. are detailed in
the American Conference of Governmental Industrial Hygienists (ACGI-Ftr) TLV booklet. For
senri- or non-permeable encapsulating protective clothing these standards can't be used
directly. However, correction factors for this type of protective clothing are listed in the
above reference. Under these conditions, the work party n'rernbers should be monitored when
the work area temperature is above 70 degrees Fahrenheit (F).
Monitoring for heat stress should be done by utilizing the buddy system (two work party
members monitoring each other for the symptoms of heat stress) or by the SSO during rest
periods. Preventative measures and proper training will help avoid serious heat stress related
illnesses. To avoid heat stress the following steps will be taken.
Adjust work schedules (i.e., modify work/rest schedules in accordance with the
above monitoring requirements).
Provide shelter or shaded areas for the protection of site workers during rest
periods.
Maintain worker's body fluids at normal levels. The fluid intake must
approximately equal the amount of water and electrolytes lost in sweat. The
following steps will be taken to accomplish this:
Maintain water temperanrre at 50 to 60 degrees F.
Have the workers drink 16 ounces of water or dilute drinks (i.e.,
electrolyte solutions such as Gatorade) prior to commencing work
activities.
Urge workers to drink eight ounces of plain water or dilute drinks at
each rest period.
Encourage workers to maintain an optimal level of physical fitness.
Acclirnatize workers to work conditions where indicated.
J I]Ii ENVIIIONM ENTAI- CONST,' I-I-AN'fS I NC
l-n tlNI)llY Stll'}l'}l-Y (-OMI'ANY l']ROll..('f lll:.,\1.I'll n Nl) SAIrh'l'Y I'}l.n Nt
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I Site personnel should be trained to recognize the signs and symptoms of heat stress and then
be able to take appropriate action. Many of these signs and symptoms are covered in the
I OSHA/NIOSH/EPA/USCG Occupational Safety and Health Guidance Manual for Hazardous
I Waste Site Activities. Some of the signs and symptoms are described below.
' :igns'11,3:['jlT:. moisr skin. Heavy sweating. Light-headedness: i,Hl'j.:l?il,1gu.r
o Confusion. Fainting
Nausea
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to a cool and uncontaminated area
with water and/or fanning
rink as soon as reasonably possible
Corrective Actions:
o Remove victirn
. Remove PPE. Cool the victim
o Give water to dI. Allow victim to rest
I L.2.2 Heat Stroke
Signs and Symptoms:o Red, hot, usually dry skin. Lack of, or reduced, perspiration
. Incoherent, delirious. Mental confusion and dtzztness. [Jnconsciousness. Staggering gait
rinated area
Corrective Actions:
o Remove the victint to a cool and uncontan
. Remove PPE
. Cool the victirn with water and lor fanning
o Give rvater-as soon as reasonably possible
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Transport to medical facility for further treatment since Heat Stroke is a medical
emergency
lf warm weather or other conditions suggest that on-site supervision by more qualified
personnel may be appropriate to protect workers from heat stress, this plan should be re-
evaluated. Specifically, the following monitoring methods may be required:
During rest periods from site work activities, the heart rate, deep body temperature and, if
possible, body water loss should be monitored when conditions warrant. Additional guidance
on this type of monitoring requirements along with recommended work/rest schedules are
provided in the Occupational Safety and Health Guidance Manual for Hazardous Waste Site
Activities. These guidelines are summarized below:
The heart rate should not exceed 110 beats/minute at the beginning of the rest
period. If this rate is exceeded, then the work cycle should be reduced by 1/3.
The deep body ternperature (about one degree F higher than the oral
ten'rperature) should not exceed 100.6 degrees F at the end of the rvork period
(an ear temperature probe unit fbr monitoring deep body temperarure can be
used for this purpose). If this temperature is exceeded, the work cycle must
also be reduced by ll3. No work party member is allowed to wear semi- or
impermeable clothing if their deep body temperature exceeds 101.6 degrees F.
If it is possible to obtain an accurate body weight (within .25 lb.) then the
weight should be measured at the beginning and the end of each work day
(providing the individual is wear-ing similar clothing). The weight recorded
should not exceed L.5% total body weight loss in a work day.
2.0 Cold Stress
The effects of extreme cold exposure (low temperatures and when the wind chill factor is
sufficiently high) are frostbite, hypothermia and impaired work ability when working at a
hazardous waste site. Some of the control measures include the use of appropriate clothing,
the availability of warm shelter, and the careful scheduling of work/rest periods. These
control measures should be taken to help prevent the worker's deep body temperature from
talling below 96.8 degrees F.
An early warning to the danger of cold stress is pain in the extremities. Durin-e prolonged
cold exposure, maximum severe shivering develops when the body tentpefature has fallen to
9-5 degrees F. 'fhis must be taken as a danger sign and exposure to cold should be
inrniediatell, terminated. For additional guidelines ort evaluation and control of cold stress
reler to the ACGIHTLV booklet.
llllt lrN\/IRONMENTA I- CONS(ll-'rn N'rS IN('
I.,.\l jNl)liY Stil)['l-\' ('Of\4 I'>AN]' I'ltOItr('l' IIIrn l-'l'tl ANt) S.'\lrll'l'\' I']l.n N 10
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Attachment 2: PPE Inspection Checklist for Clothing, Gloves and Boots
Before use:
Determine that the clothing material is correct for the specified task at hand.
Visually inspect for:. Imperfect seams. Non-uniform coatings' . Tears. Malfunctioning closures
Pressurize with air and listen for leaks (gloves only)
Hold up to light and check for pinholes.
Flex product:
Observe for cracks
Observe for other signs of shelf deterioratiort
. If the product has been used previously, inspect inside and out fbr signs of chemical
attack:
. Discoloration
. Swelling
. Stiffness
. During
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the work task, periodically inspect
Evidence of chemical attack such as
softening. Keep in mind, however,
any visible effects.
Closure failure
Tears
Puncfures
Seam discontinuities
f or:
discoloration, swelling, stiffening, and
that chemical permeation can occur without
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J BR T]N V I IiON M EN'I'A I- CONS TJ I-'fAN-fS IN(].
l-AtlNDI{Y StlPPl.Y COMPANY PRO.Illc'l' IIlrn l- I-ll ANI) SAI:l: I'Y I'1.,\N il
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APPENDIX B
Quality Assurance/Quality Control Plan
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QTJALTTY ASSURANCtr IQUALTTY CONTROL PLAN
STTtr IIYVtrSTTGATTON
LAT.INDRY SUPPLY COMPANY PROPERTY
SALT LAKE CTTY, UTAH
Prepared for:
Parsons Behle & Latimer
201 South Main Street
Salt Lake City, [Jtah 84111
Prepared by.
JBR Environmental Consultants, [nc.
8160 South Highland Drive, Suite A-4
Sandy, [Jtah 84093
.lu ly I 0, 1997
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TABLE OF CONTENTS
2.0 FIELD INSTRUMENTATION QUALITY CONTROL . .
3.0 SAMPLE REQUIREMENTS, CONTAINERS, AND PRESERVATION
4.0 ELIMINATION OF CROSS CONTAMINATION
5.0 QUALITY CONTROL AND QUALITY ASSURANCE DURING SAMPLING
6.0 CHAIN OF CUSTODY, LABELING, AND RECORD KEEPING
7.0 DATA VALIDATION, REDUCTION, AND REPORTTNG .
8.0 REFERENCES
LIST OF TABLES
Table I Sampling and Analytical Protocol Information
Table 2 Field Quality Assurance Samples
LIST OF FIGURES
Figure I Sample Label and Custody Seal
LIST OF APPENDICES
Appendix A Example Chain-of-Custody/Analytical Request Form
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JBR ENvntoNMtlN'r'n L CoN.\^ur-'[n N'rs, IN('.
[-nrJNI)rry Sr]r)r,r.\' CoMI,ANy QAiQC Pt-rrx
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I 1.0 rNTRoDUcrroN
A QA/QC plan is established to promote collection of data that are sufficient and of adequate
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their intended uses. The goals of the QA/QC program are to provide information
I This quality assurance/quality control (QA/QC) plan summarizes the procedures to be used in
I the QA/QC program for the site cleanup at laundry Supply Company's property located at
3785 West 1987 South in Salt I-ake City where perchloroethylene has been released to soil and
I . ground water. A quality assurance (QA) program is designed to define procedures for theI evaluation and documentation of sampling and analytical methods to provide a uniform basis
for relorting and managing of data. Quality control (QC) is related to tasks and procedures
I that provide a measure of performance of analytical procedures and accuracy and precision ofr data and provides a mechanism for corrective action. In addition to the QA/QC procedures
- routinely used at the laboratory to maintain State of Utah certification, JBR Environmentalr
I Consultant's Inc. (JBR) proposes to use the additional procedures discussed below.
f The objectives of the QA plan are to provide the most meaningful information at the most
f economical cost. As part of the Laundry Supply Company site investigation, QA/QC pertains
to soil and ground water sampling procedures, sample handling, chain-of-custody, and
r analvtical control.
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1) Evaluations can be made regarding the performance of field and laboratory
activities
2) Quantitative measures of accuracy and precision of data can be evaluated for
each analyte and physical test
3) Determinations can be made regarding the use and application of data to the
project.
r 2.0 FLELD TNSTRI]MENTATTON QUALITY CONTROL
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All instrumentation used in field activities will be calibrated once each day, at a minimum,
I according to the manufacturer's instructions. Calibration of instruments is necessary to
I maintain properly operating equipment and to demonstrate that instrumental response is
adequate. Data from each calibration will be transcribed into the field log book to preserve a
I ,..oid of calibration for proof of acceptability of collected field data. Information which mustI be logged during calibration includes:
1) date and time of calibration
2) names of persons calibrating the instrument
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J BR EI.IVIRONN,IITN'rNL CONSUL'rNN'I'S, INC].
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[-nrJNr)Ry srir)r,r-y c-oMpANY QA/QC Pr.nru
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3) brief statement of calibration techniques
4) observed response of instrument
5) recorlmendations about instrument maintenance or repair
In those instances when an instrument will not calibrate, the monitoring personnel will attempt
I a field repair of the impaired equipment. These personnel are responsible for seeing that sparer parts and other appropriate items for field equipment are available for field repairs to minimize
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down time. To the extent possible or practical, backup field equipment will be
I The field log book is examined by field personnel at the end of each day to review instrument
I response. Any necessary maintenance is immediately performed to assure that instruments are
in proper operating condition prior to the next field use. All records of maintenance and
I repairs and names of individuals doing the work are logged in the instrument book. It is
I anticipated that a pH meter and photo-ionization detector will be used during the field
activities.
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3.0 SAMPLE REQUIREMENTS, CONTAINERS, AND PRESERVATION
I Samples collected during the investigation will be contained and preserved according to their
type (soil or water) and the type of analysis to be performed. This section provides
I ini'ormation on the recommended container for each sample type, amount of sample requiredr for analysis, proper preservation procedures, and the maximum allowable holding time before
I analyses of samples. Preservation retards biological action and reaction of inorganic species
I which, in some cases, may render the sample uffepresentative of actual field conditions.
Preservation methods are generally limited to chemical addition, pH control, and refrigeration.
I Container size and type, preservative, and maximum holding time before analysis are specified
in Test Methods for Evaluating Solid Waste (USEPA SW-846; September 1986 as amended by
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Update I [July, 19921) and are presented below in Table 1.
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JI]R ENvIRONMIjN.fAI- CONSIII-.I.nN.IS, INC.
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L,rrJNr)ny.Srirnr-y CoN,rnnNy QA/QC PlnN
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TABL,E I Sarnpling and Analytical Protocol lnfornratiorr
A lallot'ator'1, certif ied hv the State ol'[Jtah u,ill be uscd
above.
fitr tlte anzllvtical testing descrihed
4.0 ET,T]\TINATION OF CROSS CON'I'AN,ITNA'I'ION
As a general rule, u,hen several locations are to bc santpled artd these locations include areas
expected to have lower and higher levels of contanrination, sampling will progress fi'om less
contaminated areas to more contaminated areas. This procedure lessens the chance of
unintentional contamination of cleaner samples throu-eh the use of contaminated sampling
equiprnent.
Only new, laboratory-supplied sample bottles will be used to collect samples. The appropriate
type, volume, and number of containers required is determined by the type of analysis (Table
1) and QA/QC sample requirements (Table 2).
The prevention of sample cross-contamination is
sarnpling equiprnent will be used to alleviate tltis
equiprnent will be decontaminated prior to initial
prevent cross-contamination.
a major concern. Where possible, disposable
problem. Alternatively., non-disposable
use and between sampling locations to
If non-disposable sampling equipment is used, it will be cleaned as follows:
1) Initially rinse itent rvith tap water (llom pressure sprayer or squirt bottle) to
rcnrove qross contanrinatiort
Clean itenr by washing u,ith a non-phosphate detergent and tap water. A brush
rvill be used to dislodge sedinre nts.
Rinse with tap water (using brush il'necessarY) and shake ol'l'cxcess water
llinsc u,ith distilled u,atcr.
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Sample Media Method Container Type Preservation Holding Time
4 oz. glass jar 14 days
Grouncl Water 4 oz. glass jar'
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l llli I:SVII(( )\\ll:\ l'..\t. ('t lrSl'l. l ,\\ I S. l:'.r
i ',, I \l)l{\ \t l'l'i \ ('r;\ll',\ r\ ( ) \ '()(' l'l tr
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5) Place the sampling equipment in a plastic bag and seal to prevent accidental
contamination during storage.
5.0 QUALITY CONTROL AND QUALITY ASSURANCE DTJRING SAMPLING
Sampling methods are described in detail in Section 3.0 of the Site Investigation Plan for the
Laundry Supply Property.
Samples collected for analysis will be accompanied by field blanks. Also called
decontamination or equipment blanks, field blanks check the adequacy of the decontamination
procedures used at the site. These samples will receive identification numbers similar to actual
samples and will be submitted as normal field samples. Sample collection equipment (e.g.,
trowels, bailers) is decontaminated as described above in Section 4.0. Distilled water is then
poured over the sampling equipment and the rinsate collected in a clean-sample container.
Field blanks are not required if disposable sampling equipment is used.
Trip blanks will be utilized as a quality assurance technique for ground water samples. A
Iaboratory-prepared trip blank, consisting of distilled water in a sealed sample container will
be transported and handled similarly to the actual samples. One trip blank per ground water
sampling episode will be used and will be submitted for laboratory analysis to test the integrity
of the transportation and handling methods.
Overall, field quality assurance samples typically represent 5% of all samples (EPA, 1992).
However, a duplicate or replicate sample will be collected and analyzed for every ten samples.
The guideline for analytical checks is presented in Table 2.
TABLE 2 Field Quality Assurance Samples
Note
is used.
Duplicates/
Replicates
Field Blanks Trip Blanks# of SamplesMedia
Ground Water
that field or decontamination blanks are not required if disposable sampling equipment
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JBR ENvrRoNMrrN'rAL C<;NStJr-'rnNT.s. INc.
LntJNl)try Stipr)r-y CoMrn Ny QA/QC Pr,nN
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T 6.0 CHAIN OF CUST,DY, LABELING, AND REC.RD KEEPING
t All sample bottles will be clearly labeled with an adhesive label. Example tabels are shown in
Figure 1.
I The samples will remain in the custody of the person obtaining the samples, or locked in a
securti area accessible only to the sampler. A chain-of-custody form will be completed and
I will accompany the samples to the laboratory. Coolers containing samples will be sealed withr a chain-of-custody seal prior to transfer frorn the site. An example of a chain-of-custody seal
is shown in Figure 1. All persons relinquishing or accepting custody of the samples will be
I required to sign and date/time the chain-of-custody form. Upon delivery of the iamples, ther analytical laboratory will copy the form, so that a cppy can be kept by the sampler as part of
I the field records. The chain-of-custody form may also include a listing of the analyses to be
t requested for each sample. An example of such a combined chain-of-custody/analytical
request form is included as Appendix A.
I Field notes rvill be recorded in a bound field log book with sequentially numbered pages.
Mistakes will be stricken out with a single line and initialed, not written over. Calibration
f infbrmation for each piece of field monitoring equipment will also be recorded in the log book.
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Copies of all field notes, original field note books, photographs, chain-of-custody/analytical
I request forms, shipping forms (if any) and analytical data will be stored in the project file.I
I 7.0 DATA vALIDATIoN, REDUCTToN, AND REroRTING
r Data validation for a sampling effort is an examination of all documentation for field
I instrumentation and method QC elements to ensure that all requirements have been met. Field
and laboratory documentation is verified by examining photographs, copies of all data sheets,
f log books, chain-of-custody forms, etc.I
The laboratory QC review will include, but not necessarily be limited to, the following:
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1) Overview of the data package for inclusion of all appropriate raw data and
laboratory QC documents.
2) Review of holding time for all analytes.
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.l BR ExvrRo\\rI:N'r'n I- CoN.st rr-'r'nN'r's, IN('.
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I-.,\tJ\t)t{\' .S(:t)l)t-\' (-ol\4t,n Nv Qn /QC Pt..rt
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3) Review of all QC samples for required frequency of analysis and conformance
with required control limits for matrix spike samples as required by the State
laboratory certification standards.
4) Preparation of a report identifying all data for which QC guidelines were not
met.
The field QC review will include, at a minimum, evaluation of documentation and frequency
of QC sampling.
8.0 REFERENCES
EPA, 1992. Guidance for Performing Site Inspections under CERCLA, Interim Final, U. S.
Environmental Protection Agency.
J IIR EruvrRONMr:N'r'nr- C<lN.srJr-'r'AN'r'.s, INC.
I-nuNr)ny SIr1,;,r_y CoMpn Ny QA/Q(- Pr..,\NI
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FIGURE I Sample Label and Custody Seal
Project Code Sample Number Date Time
Preservative Sampler(s) Initials
Station Location/Sanrple Description
jbr Environrnental Consultants, Inc.
8160 S. Highland Drive, Suite A-4
Sandy, UT 84093 [phone]
CUSTODY SEAL
jbr Environmental Consultants
8160 S. Highland Drive, Suite A-4
Sandy, UT 84093 [phone]
CUSTODY SEAL
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APPENDIX A
Example Chain-of-Custody/Analytical Request Form
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SAMPLER (SIGNATURE)
Phone
SEND RESTJLTS TG
JBR CONSULTAAJTS GROUP
8160 SO. HIGHI.AND DRN/E SUTTE A4
&{I.IDY, UTA}I 84GKI
(8O1) e4$4144
ATTENTION:
PROJECT NAME
CHAIN-OF-CUSTODY R ECOR D
Date Shipped Carrier
Airbill No.Cooler No.
SENT TO (r-AB):
NAME
ADDBESS
PROJECT NO.
Rolinquished by: (Signature)Received by: (Signature)Date Time
Relinquished by: (Signaturo)Received by: (Signature)Date Time
Relinquished by: (Signature)Received by: (Signature)Date Time
Relinquished by: (Signature)Received by: (Signature)
ANALYSIS REQUEST
Date Time
Sample Description Analysis RequestedDate/Time
Sampled
Sample
Crcndition Upon
Beceipt
l"*,rctions/Comments
I PR'.ESSTNG:
-Rusri
SIANDARD
,-ABLE PARTY IF DIFFERENT FROM ABOVE:
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