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SAN J <br />PART I <br />GENERAL SITE INFORMATION <br />1. Site Name: McGill Air Flow Corp <br />Address: 1747 E Charter Way <br />Contact Person: John Montell <br />Sweeps Number: <br />Proposed Date of investigation/ins <br />2. Description and brief narrative of <br />❑ New UST installation.. <br />❑ Tank Closure in Place.. <br />❑ Tank/Pipe Removal. <br />❑ Installation of Borings / Moni <br />® Hazardous waste inspection <br />3 <br />Specific Site Information: <br />Tank No.: <br />Tank Content: <br />Other: <br />4. Type of Operation: Rack <br />COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />SITE HEALTH AND SAFETY PLAN <br />Phone No: 209.466.2351 <br />12/1/03 <br />n activity: <br />Investigation. <br />Pipe Repair. <br />torirjg Wells. <br />❑ I Sampling <br />5. Release History: <br />Evidence of leaks / soil contaminati <br />Documented Groundwater contamir <br />Background and description of any <br />6. Potential Health and Safety <br />Physical Concerns: (check all that ap <br />El Heat or Cold Stress: <br />❑ Noise Sources: <br />El Oxygen Deficiency: <br />® Excavation: (falls, trips, slipping, <br />El Handling and Transfer of a Hazar <br />etc..): <br />El Confined space entry: (explosion, <br />® Heavy equipment (physical injur <br />equipment): <br />El Other, specify <br />7. Anticipated Biological Hazards: <br />C1 Snakes El Insects El <br />ElOther/Unknown (specify): _ <br />8. Narrative (provide all information <br />e.g., power lines, integrity of dikes, <br />EH 23081 (02/19/03) <br />Capacity: <br />Age: <br />El YES F1 NO <br />El YES El NO <br />investigation or incidence: <br />& describe) <br />(high ambient temp.) <br />Substance: (fire, explosions, <br />& trauma resulting from moving <br />is El Poisonous Plants <br />could impact Health and Safety, <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Chemicals Hazards <br />® Carcinogens: <br />® Corrosives: <br />❑ Dusts: <br />❑ Explosives: <br />❑ Flammables: <br />❑ Inorganic Gases: <br />® Metals: <br />❑ Oxidizers: <br />❑ PCB's: <br />PART III <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />1. Monitoring Equipment (note: Monitoring instruments must be used for all <br />operations unless appropriate rationale or restrictions are provided) <br />❑ Combustible Gas/Oxygen Meter. <br />❑ Detector Tubes (Specify). <br />❑ Photo ionization Detector. <br />❑ Organic Vapor Analyzer. <br />❑ Other, specify. <br />If monitoring instruments are not used, rationale or activity / area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: ❑ A ❑ B <br />® Hard Hat. <br />® Safety Glasses/goggles. <br />® Steel toed/shank shoes or boots. <br />❑ Flame retardant coveralls. <br />❑ Hearing protection. <br />❑ Tyvek. <br />El ❑D <br />❑ Respirator: ❑ APR ❑ SCBA <br />A/P cartridge: <br />❑ Safety vest. <br />❑ Two-way communication. <br />PART IV - PLAN APPROVAL <br />Plan Prepared by: - Vv %�+1 Date: December 1, 2003 <br />Plan Approved by: .ems � _ Date: <br />