Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMEIv"TAL HEAT "TH DMKION <br />SITE HEALTHAND SAFETY PL-kINt <br />PART I <br />GENERAL SITE INFORMATION <br />1. Site Name: <br />,Address: v <br />Contact Person: JAISP+ 4,eat °�j Phone N S e ZtZAI <br />Sweeps Number: /3/45 <br />Proposed Date or investigation/inspection: <br />2. Description and brief narrative of inspection activity.- <br />New <br />ctivity:New UST Installation [ ] UAR Investigation <br />[ ] Tank Closure in Place [ ] Tank/Pipe Repair <br />�Tank/Pipe Removal [ ] Re -excavation <br />[ ] Installation of Borings/Monitoring Wets <br />3. Soecific Site Information: <br />Tank No. x36 /, 2 4( Tank Capacity ye 5 <br />Tank Contents: S Tank Age: <br />Other: <br />4. Type of Operation: <br />5. Release History - <br />Evidence of leaks/soil contamination: [ ] YES [ ] NO <br />Documenred Groundwater contamination: [ ] YES [ I NO <br />Background and description ^ an revious investigation <br />or incidence: 4/'84?5— <br />6. Potential Health and Safety <br />P ical Concerns: (check all that apply & describe) <br />eat or Cold Stress: OF�gh bient temp.) <br />e Source: 4)6�1kCd <br />[ I Oxygen Deficie-icy: <br />�E.xcavarion: (falls, trips ,slipping, cave-ins) <br />[ I Handling and Transfer of a Hazardous Substance: <br />(fire, explosions, erc.) <br />[ ] Confined Space entry. (explosions) <br />a>�eavy equipment (physical injury & trauma resulting <br />from moving equipment) <br />[ ] Other, specify <br />7. Anticipated Biological Hazards: <br />[ ] Snakes [ I Insects [ I Rodents [ I Poisonous Plants <br />[ I Other/Unknown (specify): <br />8. Narrative (provide all information which could impact Health <br />and Safety, e.g., power lines, integrity of dikes, terrain, etc.): <br />EH23081 (2/7/92) <br />PART II <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Chemicals Hazards <br />[ j <br />Carcinogens: <br />[ j Corrosives: <br />us <br />[ ] plolo <br />sives: <br />cj-Flammables: <br />[ j Inorganic Gases: <br />[ 1 Metals: <br />[ 1 Oxidizers: <br />[ 1 PCB's: <br />PART III <br />REQU= PERSONAL PROTECTIVE <br />EQUIPMENT <br />1. Monitoring Equipment: (note: Monitoring <br />instruments must be used for all operations <br />unless appropriate rationale or restrictions are <br />provided) <br />[Combustible Gas/Oxygen Meter <br />erector Tubes (Specify) <br />[ I Photoionization Detector <br />( I Organic Vapor Analyzer <br />[ I Other, specify: <br />If monitoring instruments are not used, <br />rationale or activity /area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: [ ]A [ JB -ZeC ,`eD <br />t'"Ard hat I <br />c64- Safety glasses/goges <br />Steel toed/shank shoes or boots <br />[ ] Flame retardant coveralls <br />'[Hearing protection <br />M Tyve_k <br />M-Respiraror, circle: or SCBA <br />A/P cartridge: <br />fpcj Safety vest <br />[ ] lwo-way communication <br />PART N <br />PLAN APPROVAL <br />Plan Prepared by: 4 Date: �20 <br />Plan Approved by. Dat <br />