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o <br /> SAN JOAQUIN COU-N—rY ENI VIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART H <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> I. Site Name: �'f res_- O tI. Chemicals Hazards <br /> Address: ,JE: 'Carcinogens: <br /> Contact Person: Phone No. []Corrosives: <br /> Sweeps Number. Dusts: <br /> Proposed Date of investigation/inspection: [ J Explosives: ` <br /> Flammables: �- <br /> 2. Description and brief narrative of inspecron activity: [ Inorganic Gases: <br /> [ ] New UST Installation [ I UAR investigation _ Metals: f ,�eZ <br /> [ ] Tank Closure in Place [ I Tank/Pipe Repair [] Oxidizers` <br /> �'ank/Pipe Removal [J Re-e=avation []PCB's: <br /> [ ] Installation of Borings/Monitoring We-Is <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity. ('500 EQUIPMENT <br /> Tarek Contents: 42,7 Tars. e: <br /> Other c a ' iD .,�� 1. Monitoring Equipment: (nate: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: fps=1 ----- unless appropriate rationale or restrictions are <br /> provided) <br /> 5. Release History: X Combustible Gas/Oxygen Meter <br /> Evidence of leaks/sod contamination: [ I YES [ I NO -11[ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ I YES [ I NO [ ] Photoionization Detector <br /> Background and description of any previous investigation (I Organic Vapor Analyzer <br /> or incidence: ZIZ17 Other, specify: <br /> If monitoring instruments are not used, <br /> rationale or activity/area restrictions: <br /> 6. Potential Health and Safety <br /> Ph ical Concerns: (check all that apply&describe) <br /> Heat or Cold Stress: of Ngh ambient temp.) <br /> oise Source: la. 4__ 2. Personal Protective Equipment <br /> I Oxygen Deficiency: Level of Protection: [ lA [ lB [ IC X <br /> cavation: (falls, trips ,slipping, cave-ins) ��and hat <br /> Handling and Transfer of a Hazardous Substance: rt�Safety glasses/goggles <br /> ' [J Steel toed/shank shoes or boots <br /> fire, explosions, etc.} <br /> [ ] Confined Space en explosions) [ I Flame retardant coveralls <br /> ,* -Heavy equipment (physical injury&trauma resulting Hearing protection <br /> from moving equipment)b r. f.,h_ce— ek <br /> [ J Respirator, circle: APR or SCBA <br /> [ ] Other, specify A/P cartridge: <br /> .,*,4�,Safery vest <br /> 7. Anticipated Biological Hazards: [] Two-way communication <br /> [ ] Snakes [ ] Insects [ ] Rodents (I Poisonous Plants <br /> [ ] Other/Unknown (specify): 402 PART IV <br /> PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health �,. l_3- <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared br.0- /. Date. <br /> Plan Approved by:: __ Date: <br /> El-f23081 (7/7/92) <br /> 1 <br />