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0 w <br /> SITE HEALTH AND SAFETY PLAN <br /> PART <br /> GENERAL SITE INFORMATION PART 11 <br /> 1. Site Name:Interstate Truck Ctr—Collision D[ EVALUATION OF POTENTIAL HAZARDS <br /> Address:641 S Harrison St 1. Chemicals Hazards <br /> Contact Person:Dave Morganson Phone No:4673561_ Carcinogens:waste oil <br /> Sweeps Number: <br /> ❑Corrosives: <br /> Proposed Dale of investigation/inspection: ❑Dusts. <br /> ❑Explosives: <br /> 2. Description and brief narrative of inspection activity: Flammables:diesel fuel,acetylene,propane <br /> El New UST installation. C]UAR Investigation. )o <br /> 7�Inorganic Gases:nitrogen-asphyxiation <br /> ❑Tank Closure in Place. [I Tank/Pipe Repair. ❑Metals: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. <br /> ❑Oxidizers: <br /> El Installation of Borings/Monitoring Wells. ❑PCB's: <br /> 7 Hazardous Waste Routine Inspection <br /> 3. Specific Site Information: <br /> Tank No.: Tank Capacity: PART III <br /> Tank Content: Tank Age: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Other: I. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> operations unless appropriate rationale or restrictions we provided) <br /> 4. Type of Operation:shipping trucking&freight services for commercial& ❑Combustible Gas/Oxygen Meter. <br /> residential shippers ❑Detector Tubes(Specify). <br /> ❑Photo ionization Detector. <br /> 5. Release History: ❑Organic Vapor Analyzer. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO ❑Other,specify. <br /> Documented Groundwater contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Background and description of any previous investigation or incidence: <br /> 2. Personal Protective Equipment <br /> 6. Potential Health and Safety Level of Protection: ❑A ❑B ❑C qD <br /> Physical Concerns:(check all that apply&describe) Hard Hat. I <br /> ❑Hem or Cold Stress: of(high ambient temp.) Safety Glasses/gogglm. <br /> Noise Sources: CkSteel toed/shank shoes or boots. <br /> ❑Oxygen Deficiency: ❑Flame retardant coveralls. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): X Hearing protection. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, ❑Tyvek. <br /> etc..): ❑Respirator: ❑APR ❑SCBA <br /> `❑Confined space entry:(explosions): A/P cartridge: <br /> R tHmvy equipment(physical injury&trauma resulting from moving Safety vest. <br /> equipment): <br /> ❑Two-way communication. <br /> ❑Other,specify <br /> 7. Anticipated Biological Hazards: PART IV-PLAN APPROVAL <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants �r^,Af-- .. Q/ <br /> ❑OtherfUnknown(specify): Plan Prepared by: r V11 I✓I Date: <br /> 8. Narrative(provide all information which could impact Health and Safety, Plan Approved by: Date: <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(12/17/2002) <br />