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S, JOAQUIN COUN"I'S" ENVIRONyIE E Y HEALTH Dr-OISION <br /> SITE HEALTH IND SAF <br /> PART II <br />,TT I SITS INFOR.�MITION EVALUATION OF POTF.VnAL HAZARDS <br /> N C C L 1. Ch icals Hazards <br /> ice Name: ( Carcinogens: <br /> ddress: Z a✓ pv-' C osives: <br /> Phone No / �!� 53�/ [] <br />:ontact Person: [ ] r <br /> weeps Number. � Un�L- [ tplosives: <br />;oposed Date of investigation inspection: [ Flaramables: <br /> [ ] <br />)escription and brief narrative of inspection activity: Inorganic Gases: <br /> (] <br /> j New UST Installation [ ] UAR Investigation 1 Metals: <br /> Tank/Pi a Repair [ ] Oxidizers: <br /> a] nk Closure in Place [ ] P []PCB's: <br /> aTnk/Noe Removal [ ] Re-excavation <br /> j Installation of Borings/Monitoring Wells PART III <br />;pec <br /> iFc Sice Info ation: REQUIRED PERSONAL PROTECTIVE <br /> Spec No. Tank Capacity: Zd '�' EQUIP.ME`>T <br /> lank Contents: — � Tank Age: S 1. Monitoring Equipment: (note: vtonicoring <br />)cher: instruments must be used for all operations <br /> unles ppropriate rationale or restrictions are <br /> type of Operation: pro ded) <br /> ( Combustible Gas/Oxygen Meter <br /> release History ( J Detector Tubes (Specify) <br />.vidence of leaks/soil concamination: [ ] `/- ( 0 photoionization Detector <br />)ocumented Groundwater contamination: [ ] YES [ NO ( J Organic Vapor Analyzer <br /> 3ac'.cg:ound and description of any previous investigation ] Other, specify- <br />)r <br /> pecify)r incidence: If monitoring instruments are not used, <br /> rationale or activity/area restrictions: <br /> potencial'Health and Safety <br />?h7s cal Concerns: (check all that apply <br /> o nt temp.) <br />[\}/Heat or Cold Stress: 2. Personal Protective Equipment <br />[ ] Noi Source: Le o Protection: ( ]A [ JB [ ]C <br /> [ ] 0 ��n Deficiency: Nery <br /> � rd hat <br /> [ avation: (falls, trips ,slipping, cave-ins) <br /> [ andling and Transfer of a Hazardous Substance: <br /> glasses/goggles <br /> u explosions etc.) toed/shank shoes or boots <br /> (f P [ J Flame retardant coveralls <br /> ( ] nhn.ed Space entry: (explosions) Hearinprotection <br /> ( .eavy equipment (physical injury& trauma resulting [ ] g <br /> from moving equipment) [ ] Tyvek <br /> ( J Respirator, circle: APR or SCBA <br /> Ali cartridge: <br /> ( ] Other, specify [ ] Safety vest <br /> [ ) Two-way communication <br /> Anticipated Biological Hazards: poisonous Plants <br /> [ ] Snakes;• ( ] Insects [ ) Rodents [ ] PART IV <br /> ( ] Other/Unknown (specify): PLAN APPROVAL <br /> Narrative (provide all information which could impact Health plan pre aced by: Y Date: q Z3 I <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): P <br /> Plan Approved by: 1 Date: <br /> 12 <br />