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SAN JOAQUIi t COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENT AL HAZARDS <br /> I. Site Name: enc.(( SGt'y(cc_.. 1. Ch cals Hazards <br /> Address: oci-r_v- I oo 2CA S-cn ck-r� [ Carcinogens: <br /> Contact Person:Vvncc, F__6,((c,.. Phone No SIoCorrosives: <br /> Sweeps Number: go y C+ L ] Dusts: <br /> Proposed Date of investigation/inspection: [ ] Explosives: <br /> lammables• <br /> 2. Description and brief narrative of inspection activity: [ ] Inorganic Gases: <br /> [ ] New UST Installation [ ] UAR Investigation L ] Metals: <br /> [ ] Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> C-1-Tank/Pipe Removal [ ] Re-excavation [] PCB's: <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity: VCur1cu5 EQUIPMENT <br /> Tank Contents: C;A.sol�_,v Tank Age: 30 <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: Lr,n 51 c_�e �Ek;�t: � unless appropriate rationale or restrictions are <br /> provided) <br /> 5. Release History: [e,-tombusrible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: YES [ J NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES J NO [ ] Photoionization Detector <br /> Background and description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: UA R ,]4L ic��j 5bt�. L ] Other, speciry: <br /> r, U 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. Personal Protective Equipment <br /> [ ] Oxygen Deficiency: Level,af Protection: [ ]A [ ]B [ IC CID <br /> [Excavation: (falls, trips ,slipping, cave-ins) [ and hat <br /> [q Handling and Transfer of a Hazardous Substance: [-J afety glasses/goggles <br /> (fire, explosions, etc.) (I-KSteel toed/shank shoes or boots <br /> [ ] Confined Space entry: (explosions) L ] Flame retardant coveralls <br /> [q--'Heavy equipment (physical injury & trauma resulting ['Hearing protection <br /> from moving equipment) [ ] Tyvek <br /> [eRespirator, circle: APR or SCBA <br /> [ ] Other, specify A/P cartridge: <br /> [ ] Safety vest <br /> 7. Anticipated Biological Hazards: [ ] Two-way communication <br /> [ ] Snakes [ ] Insects L ] Rodents [ ] Poisonous Plants <br /> [ ] Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health I <br /> and Safety, eg., power lines, integrity of dikes, terrain, etc.): Plan Prepared by: Date: //oI <br /> Plan Approved by: Datox//_ �/� <br /> EH23081 (2/7/92) <br />