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a <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTT14I1'AL HAZARDS <br /> 1. Site Name: `*"UMd� .. 1. Chemicals Hazards <br /> Address: Carcinogens: <br /> Contact Person: Phone NoCorrosives: <br /> Sweeps Number: fflk� Dusts: <br /> Proposed Date of investigation/inspection: [ ] Explosiv <br /> ,X�Flammables: � <br /> 2. Description and brief narrative of inspection activity: [ ] Inorganic Gase . <br /> [ ] New UST Installation [ ] UAR Investigation [] Metals: <br /> [ ] Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> -tZTank/Pipe Removal [ ] Re-excavation []PCB's: <br /> [ <br /> ]-Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. l99.~D l Tank Capacity: ODD EQUIPMENT <br /> Tank Contents: O e.C- Tank Age: r+� n <br /> Other: 1. Monitoring Equipment. (note: Monitoring . <br /> instruments must be used for all operations <br /> 4. Type of Operation: unless appropriate rationale or restrictions are <br /> provided) <br /> 5. Release History: Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: YES [ ] NO [ ] etector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES NO [ ] Photoionization Detector <br /> Background and descri tion of any previous invesffgation [I 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 /> )Toise Source: bj p c K hA - 2. Personal Protective Equipment <br /> [ ] Oxygen Deficiency: Level of Protection: [ ]A [ ]B [ ]CJ <br /> XExcavation: (falls, trips ,slipping, cave-ins) Hard hat <br /> >Qiandling and Transfer of a Hazardous Substance: Safety glasses/goggles <br /> (fire, explosions, etc.) teel toed/shank shoes or boots <br /> [ ] Confined Space entry: (explosions) ``[ I Flame retardant coveralls <br /> AHeavy equipment (physical injury& trauma resulting Nearing protection <br /> from moving equipment) [ ] Tyvek <br /> [ ] Other, specify [ ] Respirator, circle: APR or SCBA <br /> cartridge: <br /> afety vest <br /> 7. Anticipated Biological Hazards: A114 [ ] Two-way communication <br /> [ ] Snakes [ ] Insects [ ] Rodents [ ] Poisonous Plants <br /> [ ] Other/Unknown (specify)• PART IV <br /> 8. Narrative (provide all information which could impact Health PLAN APPROVAL <br /> and Safety, e.g_, po er lines, integrity of dikes, terrain, etc.): Plan Prepared by: ate: :R- I- <br /> Plan Approved by: U Date: <br /> EH23081 (2/7/92) <br />