Laserfiche WebLink
SAM IOAQL-N COUNTY EiVIRONMENTAL FT-E-E 4I.TH DIVISION <br /> SITE HF—AL.TH AiND SAFEY PLAN <br /> ?.ART I PART II <br /> C NERAL SITE INFORMA=ON EVALUA=ON OF PO'T rrAL F AZARDS <br /> 1. Site Name: 5 1. chgmi to Faza_ros <br /> Address: 2Z2 F— c.t 116 [ ear=ogens: Brs1t1.�1E <br /> Contac_Person:—Ci rn T"%P Phaae Na. 5 -A C I Corrosives: <br /> Sweeps Number. 95 14-1E1=j <br /> P-00 sed Date of avestiganomAnmecdoa ( plosives: <br /> Z Description and brief narrative of amecdon ac:ivicy: C ] [aorganic Cases: <br /> ( 1 New UST Insolation C I UAR(avftcg pan C I Mem: <br /> ( ] T,ank Closure a Place ( ] Tanlr/Pive Repair ( j Oadiz_-s: <br /> TanF/Pive Removal [7 Re—seavadon CI Pa'r <br /> [ j Installation of Sor}p/Maniroring Wells <br /> PART III <br /> 3. Scedfic Site Information: REQUIIIED PFRSAN.AL PROTECTIVE <br /> Tank No. Tank Cavadty. (t EQUEP!v <br /> Tan:¢ Contents .aF Taaic Age uN <br /> Crhe* 1. Momror g Eauivme=e Cnoa Yforitor g <br /> ase meats taus-, be used lar all overadon <br /> 4. Type of Cveradaa: =-_i! ��> ��_�- unless avvrovram rationale or_es=ctons are <br /> prov:eeo. <br /> 5. Release Fistorr ombcssole Gas/Oa7gexx Meter <br /> •Adence of lea-Ws0Q concaminadoa C 1 J4-1 Crf qO [ I Oeteror Tunes (Soedr/) <br /> Doc_me_red Groundwater conraminanoa C j "ES (A-1qO ( I Phocrioniz=non Decor <br /> Back,"ouad and dese.'nnoa of nay previous avesaganaa [I Organic Vapor m;3iyz <br /> or incidence: ( I Off• 5?ec=[T- <br /> If mnnimrimg b===e= are aoc Wed, <br /> rationale or ac=xl/area resc.c='ons: <br /> 5. Potential Health and Safe-7 <br /> Physical Concerns: Ccheck ail chat apply& descce) <br /> [ I '—'ea;—or Cold Stress: °F Q:igh ambient rrrv) <br /> oise Source 1}e..ni U!� MF 2 Personal Ptpcec m Equipment <br /> C ] Denceacy L_ ac ProceT+an: (IA C I$ C IC <br /> [ <br /> on: (falls, stos supping; cave-ins) (� <br /> [ Hanaliag and Transfer of a ra:z+*^cus Substance- Cl s5e-7 tasses/gogzles <br /> (fire, explosions, etc) WTItalml. coed/sh=ic shoes or boars <br /> ( naned Soace enny: (emissions) C j •' a retardant coveralls <br /> t7 i equipment (Physical mlpry& crautpa resulting ( e3 mg pror..•m <br /> spm moving equipment) C I T77ek <br /> ( ] Respiraror, ice: PPR or SOA <br /> ( I Other. specify VD carr d,_ <br /> ( I Safe--I vest <br /> i. Anticipated 33101f gic1 r C I TwO= '"my corm=nic don <br /> C I Snakes ,,f[usecs [ Rodenrs C I Poisonous Plana <br /> C I Other/Unlaiown (specify): PART IV <br /> PLAN APPROVAL <br /> 8. Narrative Cprovide ail afatmanon which could :mpac Fealth <br /> and Safe-7, e.g.. power Lines, ate;ny of d5kes, ce rmm, etc): Plan Prepared by. Dare <br /> r "�'�'j�Q <br /> P!an Approved by. Dace: rr <br /> :2308T (2/7/92) <br />