Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> RT PART II <br /> PAI <br /> GRT SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: 1. Chemicals Hazards <br /> Address: ^" "^ ?CIz <br /> [carcinogens: r�,, 4- MOSe--/ <br /> Contact Person:S LX41 1L m Phone No.aL 992-39z8 [) Co�ves: <br /> Sweeps Number. ( ts <br /> \. <br /> Proposed Date of investigarion/inspection: w UlKa. 4 fr]' xplosives: -I•'CN r <br /> [] Flammables• <br /> 2. Description and brief narrative of inspection activity. ( ] Inorganic Gases: <br /> Az� <br /> ( ] UAR Investigation ( ] Metals: <br /> [ ] Tank/Pipe Repair [] Oxidizers: <br /> emoval I ] Re-excavation []PCB's: <br /> [ ] Installation of Borings/Monitoring Wells PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Jt122o I Tank Capacity: 10,06D EQUIPMENT <br /> Tank Contents: i�11Y J._ Fi Tank Age: Lxt.Jy,,_ <br /> Other, 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: Q a Q k unless propnate rationale or restrictions are <br /> pro ' ed) <br /> S. Release History: Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: ( ] YES [ ] NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: ( ] YES ( ] NO [ ] Photoionization Detector <br /> Background and description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: 1 .tJ 4 Nei awl [ ] 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 /> [ ] Heat or Cold Stress: of (high ambient temp.) 2. personal Protective Equipment <br /> [ ] Noise Source: <br /> ( l 9xYgan Deficient Level Protection: [ ]A [ ]B [ ]C ( ]D <br /> k non: (falls, trips ,slipping, cave-ins) Hard hat <br /> [ andling and Transfer of a Hazardous Substance: (.1 S y glasses/goggles <br /> (fire, explosions, etc.) krSteel toed/shank shoes or boots <br /> [ ] Co ed Space entry. (explosions) ( ] Flame retardant coveralls <br /> [ eavy equipment (physical injury & trauma resulting ( ] Hearing protection <br /> from moving equipment) [ ] Tyvek <br /> [ ] Respirator, circle: APR or SCBA <br /> [ Other, specify f A/P cartridge: <br /> [ ] Safety vest <br /> 7. An ' pated Biol cal H [ ] Two-way communication <br /> Snakes [ 'Insects Rodents [ ] Poisonous Plants <br /> [ ] Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by Date: <br /> Plan Approved by 911 Date: <br /> EH23081 (2/7/92) <br />