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SAN JOAQUIN COUNTY EI VIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: (-49ry-yrC141 /runs4r. �hr - 1. Chemicals Hazards <br /> Address: /6 5/ �o✓; sC /fve (] Carcinogens: <br /> Contact Person: „�„ Hynso7 Phone No. &00 -71/Z zv a Z []Corrosives: <br /> Sweeps Number. /6 5Sr \ ( ] Dusts: <br /> Proposed Date of investigation/inspecuon: '/ q3 ( ] Explosives: <br /> j4'FClammables- <br /> 2. Description and brief narrative of inspection activity: [ ] Inorganic Gases: <br /> [ ] New UST Installation [ ] UAR Investigation ( J Metals: <br /> [ ] Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> [,],ank/Pipe Removal ( ] Re-excavation []PCB's: <br /> ( ] Installation of Borings/Mortitoring Wells <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. % 51 TapkCapacirr O ,I00 EQUIPMENT <br /> Tank Contents: o se I Tank Age: ✓l <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> I instruments must be used for all operations <br /> 4. Type of Operation: � ry c 15 (9af(o' unless appropriate rationale or restrictions are <br /> provided) <br /> S. Release History. ( ] Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soa contamination: [ I YES (✓j/O ( ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: ( ] YES NO [—Motoionization Detector <br /> Background and description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: [ ] Other, specify: <br /> If monitoring instruments are not used, <br /> rationale or activity/area restrictions: <br /> 6. Potential Health and Safety <br /> Physical Concerns: (check all that apply& describe) <br /> {1 Heat or Cold Stress: of (high ambient temp.) <br /> [ ] Noise Source: 2. Personal Protective Equipment <br /> [ ] Oxygen Deficiency: Lev -of Protection: [ ]A [ ]B [ ]C kT]5 <br /> Excavation: (falls, trips ,slipping, cave-ins) d hat <br /> [ ] Handling and Transfer of a Hazardous Substance: RFte(t <br /> ty glasses/goggles <br /> (fire, explosions, etc.) l toed/shank shoes or boots <br /> [ ]confined Space entry. (explosions) ( ] Flame retardant coveralls <br /> [1 Heavy equipment (physical injury& trauma resulting [ ] Hearing protection <br /> from moving equipment) ( ] Tyvek <br /> ( ] Respirator, circle: APR or SCBA <br /> ( j Other, specify A/P cartridge: <br /> [ ] Safety vest <br /> 7. Anticipated Biological Hazards: ( ] Two-way communication <br /> [ J Snakes [ ] Insects [ ] Rodents (] Poisonous Plants <br /> [ ] Other/Unknown (specify): PART N <br /> PIAN APPROVAL <br /> S. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by. Date:J L-A/ 94 <br /> Plan Approved by. Dater ` <br /> EF23081 (2/7/92) <br />