Laserfiche WebLink
! s <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION �T EVALUATION OF POTENTIAL A$,DS <br /> 1. Site Name: f —/� 1. Chentieels Hazards <br /> Address: f& Cal`(/(� jox�✓l o!/{^d <br /> Carcinogens: <br /> Contact Person: Phone No: ❑Corrosives, <br /> Sweeps Number: /'t ,� ' ❑ 'a; /J <br /> Proposed Date of investigation/inspection:_ ` plosives:i r - n <br /> ammables0'1�_rr_eeFvent� IA� <br /> 2. Description and brief narrative of inspection activity: ❑Inorganic Gases: <br /> ❑New UST installation. ❑UAR Investigation. ❑Metals: <br /> ---���,,,❑Tank Closure in Place. ❑Tank/Pipe Repair. ❑Oxidizers: �7 <br /> Tank/Pipe Removal. ❑Re-excavation. ❑PCB's: �— Meyma ewk <br /> /❑Installation of Borings/Monitoring Wells. n Y'�^Q V /e 4 / IF <br /> PART III C(� C� n <br /> 3. Specific Site Information: .e��r7 <br /> Tank No.: Tank Capacity: Zo O(Jv �� REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank Content: l {fTFfank Age: I. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Atha. ¢0 0.5 fo .t� operations unless appropriate rationale or restrictions are provided) <br /> ❑Combustible Gas/Oxygen Meter. <br /> 4. Type of Operation: ❑Detector Tubes(Specify). <br /> �'hoto ionization Detector. (/.J,n '_ • u^-CW_ <br /> C3Organic Vapor Analyzer. <br /> 5. Release History: <br /> ❑Other,specify. <br /> Evidence of leaks/soil contamination: ElYES [INO <br /> Documented Groundwater contamination: [3 YES ❑NO If monitoring instruments are not used,mti ale or O activity/area restrictions: <br /> Background and description of any previous investigation or incidence: <br /> d( SQL <br /> 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C ®D <br /> 6. Potential Health and Safety <br /> Physical Concerns:(check all that apply&describe) ®Hard Hat. <br /> ®Safety Glasses/goggles. <br /> ❑Hear or Cold Stress: OF(high ambient temp.) <br /> ®Steel toed shank shoes or boots. <br /> ,tel Noise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: <br /> ®Hearing protection. <br /> ❑Excavation:(falls,trips,slipping,cave-ins): ❑Tyvek. <br /> ❑Handling and Transfer of Hazardous Substance:(fire,explosions, ❑Respirator. ❑APR ❑SCBA <br /> etc..): <br /> ❑Confined space entry:(explosions): A/P cartridge: <br /> ❑Heavy equipment(physical injury&trauma resulting from moving ®Safety vest. <br /> equipment): ❑Two-way communication. <br /> ❑Other,specify <br /> PART FV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: IZ� <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants plan prepared by: Jeffrey Wong Dete: C(1 <br /> ❑OtherNnlmown(specify): <br /> Plan Approved by: Date: <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(12/17/2002) <br />