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0 <br /> SAN JOAQUIN COUNTY E`NIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL STTE''INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:ND rr 1?9uw Ca D w � e�� ^ 1/�} 1. Chemicals Hazards <br /> Address: _Z6610 S, � Carcinogens: �v�vivi z_ <br /> Contact Person: Phone No. [] Corrosives, <br /> Sweeps Number. ,,- 1/� >d�,DuTff: <br /> Proposed Date of investiggarion/inspection: [ ] Explosives., <br /> �'Flammables: <br /> 2. Description and brief narrative of inspection activity: [ ] Inorganic Gases: <br /> [ ] New UST Installation [ ] UAR Investigation Metals: A, <br /> [ ] Tank Closure in Place [] Tank/Pipe Repair C ] Oxidizers: <br /> �Tank/Pipe Removal [ J Re-excavation [] PCB's: <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Soecific Sire Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No.'�-1 * 01;?, Tank Capacity. 0Dr7 EQUIPMENT <br /> Tank Contents Tank Age: nW - <br /> Othcr; J 1. Monitoring Equipment. (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: U ,nD ��nlcM_ J unless appropriate rationale or restricrions are <br /> provided) <br /> 5. Release History Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: ( I YES �NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES NO ( ] Phoroionization Detector <br /> Background and description of any previous investigation C] 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 /> ea or Cold Stress:-'IDO °F (high ambient temp.) <br /> Noise source: h t¢P hiaP 2. Personal Protective E='pmenr <br /> J <br /> ] Oxygen Deficiency Level of Protection: ( ]A [ ]B [ ]C Xb <br /> cavadon: (falls, trips ,slipping, cave-ins) Hard herr /\ <br /> andling and Transfer f a Hazardous Substance: Safery glasses/goggles <br /> (fire, explosions, etc) Steel toed/shank shoes or boots <br /> [ ] Confined Space entry: (explosions) l Flame retardant coveralls <br /> eavy equipment (physical injury & trauma resulting `'Hearing protection <br /> from moving equipment)- a GX)0-(_ C l Tyvek <br /> [ ] Respirator, circle: APR or SC3A <br /> Other, specify 0 A/P cartridge: <br /> Safery vest <br /> 7. Anticipated Biological Hazards: [ l Two-way communication <br /> ( ] Snakes [ ] Insects [ ] Rodents C ] Poisonous Plants <br /> [ ] Other/Unknown (specify): PART P/ <br /> PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health bu`�.j� <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by i c Date: 7-,23-Y4 <br /> Plan Approved by: I— Dare: <br /> EH23081 (2/7/92) �q�� <br />