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Ago& "A" <br />N a <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br />SITE HEALTH AND SAFETY PLAN <br />PART PART <br />GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br />1. <br />Site Name: i Sl lahc s <br />1. Chemicals Hazards <br />Address: <br />C I Carcinogens: <br />Contact Person: =3 mt-L\y-cAA,\ Phone No.H62�-e707 <br />Corrosives: <br />Sweeps Number. 1 ZSj � 11. <br />Dusts: <br />Proposed Date of investigation/inspection: AO r; <br />EX*sives: <br />"ammables: <br />2. <br />Description and brief narrative of inspection activity. <br />Inorganic Gases: <br />New UST Installation C I UAR Investigation <br />Metals - <br />Tank Closure in Place Tank/Pipe Repair <br />Oxidizers: <br />KTank./Pipe Removal Re -excavation <br />PCB's: <br />Installation of Borings/Monitoring Wells <br />PART III <br />3. <br />Specific Site Information: <br />REQUIRED PERSONAL PROTECTIVE <br />Tank No. k 2. b"I't - 01 Tank Capacity-. 550 <br />EQUIPMENT <br />Tank Contents: LJ Q s +e o,' Tank Age: <br />Other. <br />1. Monitoring Equipment: (note: Monitoring <br />instruments must be used for all operations <br />4. <br />Type of Operation: <br />unless appropriate rationale or restrictions are <br />provided) <br />5. <br />Release History: <br />Evidence leaks/soil YES <br />I Combustible Gas/Oxygen Meter <br />of contamina4on: I I <br />I ?_etector Tubes (Specify) <br />Documented Groundwater contamination: O <br />[-TPhotoionization Detector <br />Background and description of any previous investigation <br />Organic Vapor Analyzer <br />or incidence: <br />Other, specify: <br />A'-- �-"- -I 'If <br />monitoring instruments are not used, <br />-51,1 ,1, <br />rationale or activity /area restrictions: <br />6. <br />Potential Health and Safety <br />Physical Concerns: (check all that apply & describe) <br />Heat or Cold Stress: OF (high ambient temp.) <br />Noise Source: <br />2. Personal Protective Equipment <br />Oxygen Deficiency: <br />LeINL4fProtection: [ ]A [ ]B [ ]C <br />H-r-xcavation: (falls, trips slipping, cave-ins) <br />H <br />�jHandling and Transfer of a Hazardous Substance: <br />(fire, explosions, etc.)��teel <br />of glasses/goggles <br />toed/shank shoes or boots <br />C I Confined Space entry. (explosions) <br />Flame retardant coveralls <br />[ ] Heavy equipment (physical injury & trauma resulting <br />Hearing protection <br />from moving equipment) <br />Tyvek <br />]Respirator, circle: APR or SCBA <br />Other, specify <br />A/P cartridge: <br />Safety vest <br />7. <br />Anticipated Biological Hazards: <br />Two-way communication <br />Snakes Insects Rodents Poisonous Plants <br />Other/Unknown (specify): <br />PART <br />8. <br />Narrative (provide all information which could impact Health <br />PLAN APPROVAL <br />and Safety, e.g., power lines, integrity of dikes, terrain, etc.): <br />Plan Prepared by: Date: -_/9 <br />6 <br />Plan Approved by: AIL Date:_�_Z451_ <br />EH23081 (2/7/92) <br />