Laserfiche WebLink
10 0 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br />SITE HEALTH RIND SAFETY PLANE <br />lRT I <br />PART 11 <br />EVALUATION OF POTFIiTIAL HAZARDS <br />;NERAL SITE INFORM XnON <br />i <br />1. Chemicals Hazards <br />Site Name:. <br />Address- <br />C Carc inogeas: <br />- <br />Contact Person: Phone o. <br />(] Corrosives: <br />Dusts: <br />Sweeps Nurr. <br />Proposed Dare of investigation/inspection: <br />Explosives: <br />Flammables: <br />Description and brief narrative of inspection activity: <br />Inorganic Gases: <br />New UST Installation UAR Investigation <br />Metals: <br />Tank Closure in Place Tank/Pipe Repair <br />E I Oxidizers: <br />Tank/Pipe Removal Re -excavation <br />PCB!s: <br />Installation of Borings/Monitoring Wells <br />tg 60 <br />Soecific Site Infoparran, <br />Tank No. i Tank Capacity: <br />Tank Conceficsi Tank Age: J <br />Other: <br />Type of operation: <br />Release History. <br />Evidence of leaks/soil contamination: EIYES EINO <br />Documented Groundwater contamination: C I YES C ] NO <br />Background and description of any previous investigation <br />or incidence: <br />Pocencial'Health and Safety <br />Physical Concerns: (checit, all that apply & describe) <br />Heat or Cold Stress: IF (high ambient temp.) <br />Noise Source: <br />E I oxygen Deficiency: <br />Excavation: (falls, trips slipping, cave-ins) <br />Handling and Transfer of a Hazardous Substance: <br />(fire, explosions, etc.) <br />Confined Space entry: (explosions) <br />Heavy equipment (physical injury & trauma resulting <br />from moving equipment). <br />Other, specify <br />Anticipated Biological Hazards: <br />Snakq; [ ] Insects [ ] Rodents poisonous Plants <br />Other/unknown (specify): <br />A <br />vP00 REQUMED PERSONAL PROTECTIVE <br />81000 EQU1PMENT <br />Narrative (provide all information which could impact Health <br />and Safety, e.g., power lines, integrity of d&es, terrain, etc.): <br />110 <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 />Detector Tubes (Specify) <br />Photoionization Detector <br />E I Organic Vapor Analyzer <br />[ ] Other, specify* <br />If monitoring instruments are not used, <br />rationale or activity /area restrictions: <br />2. Personal Protective Equipment <br />Level of Protection: C ]A I 1B I IC )<D <br />Hard hat <br />,iSafety glasses/goggles <br />Steel toed/shank shoes or boots <br />Flame retardant coveralls <br />E I Hearing protection <br />[ ] Tyvek, <br />C Respirator, circle: APR or SCBA <br />Alp cartridge: <br />Safety vest <br />Two --way communication <br />PART IV <br />PLAN APPROVAL <br />Plan Prepared by: Date: <br />Plan Approved by"' Date: <br />