Laserfiche WebLink
SAiN JOAQUIN COUN' Y ENVIRONyIENTAL HEAL'i ri LiVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> 'ART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> . Site Name: ( Ro/y5 ��^� � 1. Chemicals Hazards <br /> Address: N Ri CA 376 [] Carcinogens: <br /> Contact Person: hone No. — S�fB [] Corrosives: <br /> Sweeps Number. 53 [ ] Dusts: <br /> Proposed Date of invest' ation/inspection: [ ] Explosives: <br /> [] Flammables: <br /> 2. Description and brief narrative of inspectiona�cu'ry: [ j Inorganic Gases: <br /> ( ) New UST Installation [ ] UAR Investigation [) Metals: <br /> ( j Tank Closure in Place ( ] Tank/Pipe Repair [ ] Oxidizers: <br /> J Tank/Pipe Removal [ ] Re-excavation ()PCB's: <br /> ( ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: 'L°°° REQUIRED PERSONAL PROTECTIVE <br /> Tank No. I •F-'t/ Tank Capacity: 7r004 EQUIPMENT <br /> Tank Contents:5,dG d-7 UG, . Tank Age: <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: unless appropriate rationale or restrictions are <br /> provided) <br /> S. Release History: [ ) Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ j YES [ ] NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES [ ) NO [ ] Photoionization Detector <br /> Background and description of any previous investigation [j 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 /> [ ] Heat or Cold Stress: of (high ambient temp.) <br /> [ ) Noise Source: 2. Perso Protective Equipment <br /> [ ] Oxygen Deficiency: Lev of Protection: [ ]A ( jB [ ]C ( JD <br /> [ ] Excavation: (falls, trips ,slipping, cave-ins) [ Hard hat <br /> [ ] Handling and Transfer of a Hazardous Substance: [ ] Safety glasses/goggles <br /> (fire, explosions, etc.) [ ] Steel toed/shank shoes or boots <br /> [ ] Confined Space entry: (explosions) [ J Flame retardant coveralls <br /> [ ] 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 /> [ J Safety vest <br /> 7. An ' ipated Biol gical Hazar [ ] Two-way communication <br /> [ makes;• [�nsects [l]ht dents oisonous 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: Date:1�/Z <br /> 12 <br />