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SAM JOAQUIN COUNTY EiWIRONMaNTAL HEALTH DIVISION <br /> S= HEALTIH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL. Sr1E INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: C he �.�... 1. Chemicals Hazards <br /> l;{ /4721 �_ <br /> Address: 7 7 C R I t"2, <br /> Contact Person: Phone No. (] Corrosives: <br /> Sweeps Numbe_� Dusrs: - <br /> Pr000sed Date of investigation/inspec ' : rc,T I C95 [ ] Explosives: <br /> Flammables: <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: <br /> .�5<7ank/Pipe Removal ( ] Re-excavation []PCBs: <br /> ( ] Installation of Borings/Monitoring Wells <br /> PART M <br /> 3. Specific Sire Information: t. 3 ; 16'060J' .L REQUIRED PERSONAL PROTECTIVE <br /> Tank No. t'-4 3 T Tank Capacity. 0?-5,6b09'4f- IiWO EQUIPMENT <br /> Tank Contents: I — A44ft V<4'c2Pa3ilc Age: � (o <br /> Other K it — U'4<f Ys i 1. Monitoring Equipmenr: (note: Monitoring <br /> ins imenrs must be used for all operations <br /> 4. Type of Operation: S P ry l (.F_ StATi o r11 unless appropriate rationale or restrictions are <br /> pro d) <br /> 5. Release History- NCombustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ ] `IES [ I NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES [ ] NO [ ] Photoicnization Detector <br /> Backe ound and description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: 11)90 �uZ M'Prr4�L ('W� I, [ ] Other, specify: <br /> If maniro=' g instruments are aoc used, <br /> rationale or activity/area restrictions: <br /> e �+M•� e4ea'ca Ua°fi o� . <br /> 6. Pocandal Health and Safety � Se G SP <br /> Phys' Concerns: (check all that apply & describe) <br /> ar or Cold Stress: J�b aF (high ambient temp.) <br /> [ wse Source: ¢ c. , . [_ 2. Personal Protective Equipment <br /> [ ] Oxygen Deficiency: Lev of Protection: CIA [ ]B ( ]C/kfD <br /> ;Excavation: (falls, trips ,slipping, cave-ins)7ANIChni' L M�rrd hat <br /> [ ] Handling and Transfer of a Hazardous Substance: [s�Sa 4 ty glasses/goggles <br /> (fire, explosions, etc) (reel coed/shaak shoes or boots <br /> [ ] Confined Space entry: (explosions) ( ] l;lame retardant coveralls <br /> Heavy equipment (physical injury & trauma resulting (.?Hearing protection <br /> from moving equipment) ( ] Tyvek <br /> [ ] Respirator, circle: APR or SCBA <br /> �] Other, specify U 5 �/P cartridge: <br /> ax 4t) a o5 wQ" Safety vest <br /> 7. Anticipated Biological Hazards: ( ] Two-way communication <br /> [ ] Snakes ( ] Insects [ ] Roden [ ] Poisonous Plants <br /> [ ] Other/Unlmown (specify): PART N <br /> PLAN APPROVAL <br /> S. 1Narrarive (provide all information which could impact Healths— <br /> and Safety, e_g., power lines, integrity of dices, terrain, etcMan an Prepared by.-0�-" Date: <br /> Plan Approved by Date:l0_TQN`7 {� <br /> EH23081 (2/7/92) <br />