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I <br /> SAN JOAQUIN COUN'T'Y ENVaONMENTAL, HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION <br /> EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: L i 1 Q�� �-� 1. Chemicals Hazards <br /> Address: ' ll. S. I C�c, L; [J"C'arcinoge_^s: -7- <br /> Contact <br /> Contact Person: j,w, �=.sem Phone No. - U6cI:�X- [] Corrosives: <br /> Sweeps Number: [dDusts: <,, ACC7"_-(a_, <br /> Proposed Date of investigation/inspection: ( ] Emlosives: <br /> �1amm_ables: C0.`anL.�� ��, <br /> 2. Description and brief narrative of inspection activiry [ j Inorganic Gases: <br /> [ ] New UST Installation [ ] UAR Investigation ( j Metals: <br /> [ ] Tank Closure in Place [ ] Tank/Pipe Repair ( ] Oxidizers: <br /> ( rTank/Pipe Removal [ ] Re-excavation [I PC3's: <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Soecific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. c t-IS(o3-Drank Capacity: EQUIPMENT <br /> Tank Conrenrs: U Tank Age: <br /> Other: 1. Moniroring Equipmenr. (note: Monitoring <br /> ins--ume_nts must be used for all operations <br /> 4. Type of Cpe_*ation: v-y cam. �y�CZ��C�.1 unless appropriate rationale orrestncrions are <br /> provided) <br /> 5. Reiease History: [,']Combustible Gas/Oxygen Meter <br /> F-vidence of leaks/soil contaminarion: [ ] YES &-NO [ ] Detector Tubes (Specify) <br /> Doc•,unented Groundwace_r contamination: [ I YES [v]w0 [ ] Photoionizarion Detector <br /> Background and descziption of any previous investigation [I Organic Vapor Analyzer <br /> or incidence: ( j Other, specify: <br /> if Wonitorng insa:menrs are not used, <br /> rationale or activiry/area restrictions: <br /> 6. Potential Healrli and Safety <br /> Physical Concerns: (check all char apply & describe) <br /> W� Teat or Cold Stress: OF (high ambient temp.) <br /> ( r''Noise Source: Z. Personal Protective Equipment , <br /> ( J qXygen Deaciency: Level of Protection: [ 4A [ ]B [ IC VID <br /> ( slipping, ,.ard hat ` <br /> Excavation: (falls, trips cave-ins) G� <br /> [ ] Handling and Transfer of a Hazardous Substance: VI Safery glasses/goggles <br /> (fire, explosions, erc.) [vj'Sreel toed/shank shoes or boors <br /> [ ] Confined Space entry. (explosions) ( I Flame retardant coveralls <br /> [ ] Heavy equipment (physical injury& trauma resulting [ ] Hearing protection <br /> from moving equipment) 13C1_Ck`'��=� �_ 1- :� [ I Tyve-k <br /> respirator, circle: APR or SCBA <br /> [ I Other, specify /P cartridge: <br /> ( I Safery vest <br /> 7. Anricipared Biological Hazards: [ j Two-way communication <br /> [ ] Snakes [ ] Insects [ ] Rodents ( ] Poisonous Plants <br /> [ I Other/Unknown (specify): PPRT IV <br /> PLAIN APPROVAL <br /> 8. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, inregnry of dikes, terrain, etc.): Plan Prepared by: Dare: <br /> Plan Approved by. i Dare: - <br /> E:-I23081 (2/7/92) <br />