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SAV JOAQUIN COUNTY ENVIRONMENTAL HEALTH`'61VISION <br /> SITE HEALTH AND SAFETY PLAN <br /> RT I PART II <br /> VER11L SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> Site Name: 6:"7';/< 1. CC emicals Hazards <br /> Address: lassoo 14or/o-i e..1 `f l'7 Carcinogens: <br /> :ontact Person: Rcv Vloo ict, Phone No..xo?-53s-- 9y175' [] Corrosives: <br /> Sweeps Number. /94.3 I ] Dusts: <br /> ?,-oposed Date of investigation/inspection: ;24-119Z— [ ] Explosives: <br /> cirnammables- <br /> Description and brief narrative of inspection activity: [ ] Inorganic Gases: <br /> ] New UST Installation [ ] UAR Investigation ;+' [ ] Metals: <br /> ( j Tank Closure in Place [ ] Tank/Pipe Repair [] Oxidizers: <br /> L:eank/Pipe Removal [ j Re-excavation []PCB's: <br /> ( j Installation of Borings/Monitoring Wells <br /> PART III <br /> Soecinc Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity- EQUIPMENT <br /> Tank Contents: Tank Age: <br /> Other 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> Type of Operation: A012CI C'o�x�rrrc;/�`^� unless appropriate rationale or restrictions are <br /> provided) <br /> Release History: J [+1 Combusc'ble Gas/Oxygen Meter <br /> -Evidence of leaks/soil contamination: [ ] YES (-7j '0 ( J Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES VNO ( ] Photoionization Detector <br /> 3ackground and description of any previous investigation, [] Organic Vapor Analyzer <br /> n incidence: [ ] Other, specify: <br /> If monitoring instruments are not used, <br /> rationale or activity/area rescrictions: <br /> ?otenrial Health and Safety <br /> 'hysical Concerns: (check all that apply& descrioe) <br /> ,; 'Heat or Cold Stress: yG' of (high ambient temp.) 2. Personal Protective Equipment <br /> ] Noise Source: <br /> ] Oxygen Deficiency Level of Protection: [ ]A [ ]B [ ]C D <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) [ ] Flame retardant coveralls <br /> ] Heavy equipment (physical injury& trauma resulting [ ] Hearing protection <br /> from moving equipment) [ ] Tyvek <br /> I J Respirator, circle: APR or SCBA <br /> ( ] Other, specify <br /> A/P cartridge- <br /> [ ] Safety vest <br /> Anticipaced Biological Hazards: [ ] Two-way communication_ <br /> ( ] Snakes;- [ ] Insects [ ] Rodents [ ] Poisonous Plants PART N <br /> ( ] Other/Unknown (specify): PLAN APPROVAL <br /> Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by l�Cn�- Date: ///i/4_- <br /> Plan Approved by, Date: -- <br /> 12 <br />