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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFE T PLAN <br /> PART I flU�� PART 11 <br /> GENERAL SITE INFORMATION "l` EVALUA N OF POTENTIAL HAZARDS <br /> 1. Site Name: EXXDP `� 1. s Hazards <br /> Address: !1 [ C cinogens• <br /> Contact Person. Phone No. [] o sives: . <br /> Sweeps Number. '/ [ ts: <br /> Proposed Date of investigation/inspection: `�7` rM <br /> sives: <br /> ables: <br /> 2. Description and brief narrative of inspection activity. r anic Gases: <br /> New UST Installation [ ] UAR Investigation al <br /> [ ] Closure in Place [ ] Tank/Pipe Repair [] 'dizers• <br /> [ ank/Pipe Removal [ ] Re-excavation CB's: <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. I — q Tank Capacity: EQUIPMENT <br /> Tank Contents: Tank Age: 2 i' <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 114. Type of Operation: ad,n unless propriate rationale or restrictions are <br /> Provide <br /> ed) <br /> 5. Release History: / [ ombustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [a [ ] NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ YES [ ] NO [ ] Photoionization Detector <br /> Background and description of any previous investigation [J Organic Vapor Analyzer <br /> or incidence: M ()Vb Lee c j oT�n,&� [ ] Other, specify: <br /> If monitoring instruments are not used, <br /> rationale or activity/area restrictions: <br /> 6. Pote 'al Health and Safety <br /> Phical Concerns: (check all that apply& describe) <br /> CU <br /> Heat r Cold Stress: of (high ambient temp.) <br /> [ ] No' a urce: 2. Person Protective Equipment <br /> [ ] en Deficiency: Lev f otection: [ ]A [ ]B [ ]C <br /> [ cavation: (falls, trips ,slipping, cave-ins) d t <br /> [ an ing and Transfer of a Hazardous Substance: [ ty glasses/goggles <br /> (fir , explosions, etc.) [ teel toed/shank shoes or boots <br /> [ ] nfined Space entry. (explosions) [ ] Flame retardant coveralls <br /> eavy 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 /> [ ] Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dices, terrain, etc.): Plan Prepared by. ov Date: <br /> Plan Approved by: Date: <br /> EH23081 (2/7/92) <br />