Laserfiche WebLink
• 0 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br />SITE HEALTH AND SAFETY PLAN <br />PART I PART 11 <br />GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br />1. <br />Site Name: _� boon 1^1+��E� <br />1. Chemicals Hazards <br />Address: S. Sic <br />[]Carcinogens: <br />Contact Person: ua\1- Otn 611 Phone No. SSS -3o3S <br />[] Corrosives: <br />Sweeps Number. / `Ib"/ <br />[ ] Dusts: <br />Proposed Date of investigation/inspection: <br />[] Explosives: <br />,� Flaammables: <br />2. <br />Description and brief narrative of inspection activity: <br />(] Inorganic Gases: <br />[ ] New UST Installation [ ] UAR Investigation <br />[ ] Metals: <br />[ ] Tank Closure in Place (] Tank/Pipe Repair <br />[ ] Oxidizers: <br />(']'tank(Pipe Removal [ ] Re -excavation <br />[ ] PCB's: <br />(] Installation of Borings/Monitoring Wells <br />PART III <br />3. <br />Specific Site Information: <br />REQUIRED PERSONAL PROTECTIVE <br />Tank No. I `}461 - o t Tank Capacity: <br />EQUIPMENT <br />Tank Contents: c F e 5 e ( Tank Age: v, (- <br />Other: <br />1. Monitoring Equipment: (note: Monitoring <br />4. <br />` n \ <br />Type of Operation: A S ds Tr; ¢ i�) I �` !2c <br />instruments must be used for all operations <br />unless appropriate rationale or restrictions are <br />provided) <br />5. <br />Release History: <br />[ ] Combustible Gas/Oxygen Meter <br />Evidence of leaks/soil contamination: ( ] YES [ ]'NO <br />[ ] Detector Tubes (Specify) <br />Documented Groundwater contamination: [ ] YES [-T-90 <br />( ]'Pl"iotoionization Detector <br />Background and description of any previous investigation <br />( ] Organic Vapor Analyzer <br />or incidence: <br />[ ] Other, specify: <br />If monitoring instruments are not used, <br />rationale or activity /area restrictions: <br />6. <br />Potential Health and Safety <br />Physical Concerns: (check all that apply & describe) <br />[eat or Cold Stress: °F (high ambient temp.) <br />[ ] Noise Source: <br />2. Personal Protective Equipment <br />[ ]Ogen Deficiency- <br />Level of Protection: [ ]A [ ]B [ ]C [� <br />[ cavation: (falls, trips ,slipping, cave-ins) <br />(-J-Hard hat <br />N- i—ndling and Transfer of a Hazardous Substance: <br />[,]-Safety glasses/goggles <br />(fire, explosions, etc.) <br />(mel toed/shank shoes or boots <br />[ ] Confined Space entry: (explosions) <br />[ ] Flame retardant coveralls <br />[ ] Heavy equipment (physical injury & trauma resulting <br />H -Hearing protection <br />from moving equipment) <br />[ ] Tyvek <br />[ ] Respirator, circle: APR or SCBA <br />[ ] Other, specify <br />A/P cartridge: <br />[ ] Safety vest <br />7. <br />Anticipated Biological Hazards: <br />[ ] Two-way communication <br />[ ] Snakes [ ] Insects [ ] Rodents [ ] Poisonous Plants <br />[ ] Other/Unknown (specify): <br />PART IV <br />PLAN APPROVAL <br />8. <br />Narrative (provide all information which could impact Health <br />and Safety, e.g., lines, integrity of dikes, terrain, etc.): <br />Plan Prepared by: Date: '5 /Z -9Z <br />power <br />_ <br />Plan Approved by: Date: <br />EH23081 (2/7/92) 10 <br />40 <br />