Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIROMMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> kRT I PART II <br />:,NEPAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> Sice Name: l t5+ 1. Cicals Hazards <br /> Address: eF ( Carcinogens: <br /> Contact Person: Len boh►Kc, Phone No. q51 155_1 [] Corrosives: <br /> Sweeps Number. lDqR (Xusts: <br /> Proposed Date of investigation/inspection: ulk, k [ losives: <br /> [ lammables: <br /> Description and brief narrative of inspection activity: ( ] Inorganic Gases: <br /> [ J New UST Installation [ J UAR Investigation [ J Metals: <br /> ( J Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> (\i/Tank./Pipe Removal [ J Re-excavation [] PCB's: <br /> ( ] Installation of Borings/Monitoring Wells <br /> PART III <br /> Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity: I L I ODD EQUIPMENT <br /> Tank Contents: 0,4,, Tank Age: JC4�j jr!5, <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> �n/� <br /> Type of Operation: 1 � 6oiA na., unles ppropriate rationale or restrictions are <br /> P <br /> ro ded) <br /> Release History: [ Combustible Gas/Oxygen Meter <br /> Evidence of Ieaks/soil contamination: [ J YESV00 <br /> Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ j YES [ j 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 /> Poce ial Health and Safety <br /> Ph ical Concerns: (check all that apply & describe) <br /> [ Heat or Cold Stress: of (high ambient temp.) <br /> [ J No. a Source: 2. Personal Protective Equipment <br /> [ ] gen Deficiency: <br /> Lev of Protection: [ ]A [ JB [ IC [ <br /> ( cavation: (falls, trips ,slipping, cave-ins) [� rd hat <br /> [ andling and Transfer of a Hazardous Substance: [�ety glasses/goggles <br /> (fire, explosions, etc.) ( teeI toed/shank shoes or boots <br /> [ I C fined Space entry: (explosions) ( ] 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 /> [ ] Safety vest <br /> Anticipated Biological Hazards: [ ] Two-way communication <br /> ( ] <br /> Snakes;- [ ] Insects [ J Rodents [ J Poisonous Plants <br /> ( J Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> Narrative (provide all information which could impact Health `� ((''�� <br /> and Safery, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by: " Date: 'D Z�D <br /> Plan Approved by:' Dace: <br /> 12 <br />