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0 . Ah <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH IVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> 'ART I PART 11 <br /> GENERAL SITE INFORMA'110N EVALUATION OF POTENTIAL HAZARDS <br /> I. 6n 01 1. Chemicals Hazards <br /> Site Name: J- <br /> Address: Carcinogens: <br /> Contact PI—erson:99i �Phone�fto- (] Corrosives: <br /> Sweeps Number: [ ] Dusts: <br /> Proposed Date of Avestfg—ation./inspection: [ ] Explosives: <br /> Flammables: <br /> 2. Description and brief narrative of inspection activity- Inorganic Gases: <br /> New UST Installation UAR Investigation Metals: <br /> TloKk' Closure in Place Tank/Pipe Repair Oxidizers: <br /> [1,yTank/Pipe Removal Re-excavation PCB's: <br /> [ ] Installation of Borings/Monitoring Wells PART III <br /> 3. Specific Site Information: r G I REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity: �,WI>) EQUIPMENT <br /> Tank Contents: Tank Age: <br /> 1. <br /> Monitoring Equipment: (note: Monitoring <br /> Other: instruments must be used for all operations <br /> 4. Type of Operation: unless appropriate rationale or restrictions are <br /> provided) <br /> Combustible Gas/Oxygen Meter <br /> S. Release History: <br /> Evidence of leaks/soil contamination: [ ] YES [ ] NO Detector Tubes (Specify) <br /> [ ] YES [ ] NO Photoionization Detector <br /> Documented Groundwater contamination: <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 & describe) <br /> Physical Concerns: (check all that apply <br /> Heat or Cold Stress: OF (high ambient temp.) 2. Personal Protective Equipment <br /> Noise Source: Level of Protection: [ ]A ( ]B [ ]C I )D <br /> Oxygen Deficiency: <br /> Excavation: (falls, trips slipping, cave-ins)_ Hard hat <br /> Handling and Transfer of a Hazardous Substance: Safety glasses/goggles <br /> (fire, explosions, etc.) Steel toed/shank shoes or boots <br /> Confined Space entry: (explosions) Flame retardant coveralls <br /> Heavy equipment (physical injury & trauma resulting Hearing protection <br /> from moving equipment) Tyvek <br /> Respirator, circle: APR or SCBA <br /> Other, specify A/P cartridge: <br /> Safety vest <br /> 7. Anticipated Biological Hazards: Two-way communication <br /> Snakes.- Insects Rodents Poisonous Plants <br /> PART IV <br /> Other/Unknown (specify): PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Pre0ared by: AL4�1�-4 Date: <br /> Plan Approved by: Date:_ <br /> 12 <br />