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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIlIpf; <br /> SITE HEALTH AND SAFETY PLAN ' " <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL F A7.ARDS <br /> 1. Site Name: _51,&a4;,m 4v 1. Ch5picals Hazards <br /> Address- 52a( 2,d. [ arcinogens- ":r .X' <br /> Contact Person: Phone No. [] Corrosives: <br /> Sweeps Number. [ ] Dusts: <br /> Proposed Date of investigation/inspection: [ ] losives: <br /> LzlFammables: C! 1',.A 1 = <br /> 2. Description and brief narrative of inspection activity: [ ] [aorganic Gases: <br /> [ J New UST Installation [ 1 UAR Investigation [ etals• <br /> wank Closure in Place [ ] Tank/Pipe Repair [ J Oxidizers: <br /> [ J Tank/Pipe Removal [ ] Re-excavation [J PCB's: <br /> [ J Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity: ti-.S" EQUIPMENT <br /> Tank Contents: Tank Age: <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> ` instruments must be used for all operations <br /> 4. Type of Operation: G ay-[- .i 0 6 k�A e ant unless appropriate rationale or restrictions are <br /> provided) <br /> 5. Release History- [ ] Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ ] YES [ J NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination:TAYES [ 1 NO [ J Photoionization Detector <br /> Background and description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: [ ] Other, specify- <br /> 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 /> [ ] gen Deficiency: Levoof Protection: [ ]A [ 1B [ 1C <br /> vation: (falls, trips ,slipping, cave-ins)-- Hard hat <br /> Handling and Transfer of a Hazardous Substance: [ ] S ery glasses/goggles <br /> (5re, explosions, etc.) Steel toed/shank shoes or boots <br /> [ ed Space entry. (explosions) y—i ,a��, ;�- [ ] Flame retardant coveralls <br /> [ "Heavy equipment (physical injury& tra resulnng VrHearing protection <br /> from moving equipment) c�1� JJ. [ 1 Tyvek <br /> [ <br /> ] Respirator, circle: APR or SCBA <br /> [ ] Other, specify cartridge: <br /> Vf Safety vest <br /> 7. Anticipated Biological Hazards: VT Two-way communication <br /> [ J Snakes Insects Rodents [ 1 Poisonous Plants <br /> [ ] Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health /// <br /> and Safety, a . power roes, integrity of dikes, terrain, etc.): Plan Prepared by Date: - o' <br /> Plan Approved by Date:' <br /> EH23081 (2/7/92) <br />