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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALi t-i DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> SRT I PART II <br /> aNERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> Site Name: ��� �UN>60– <br /> u/ `' 1. Chemicals Hazards <br /> Address: ,-1270,/ / • l/�� –� ' . -rtarcinogens: <br /> Contact Person: Phone [J Corrosives: <br /> Sweeps Number: 0 V 5'` [ ] Pusts: <br /> Proposed Date of investigation/inspection: "Plosives: <br /> j?F1^ammnabIes: <br /> Description and brief narrative of inspection activity: ( J Inorganic Gases: <br /> [ ] New UST Installation ( ] UAR Investigation [ ) Metals: <br /> ( J Tank Closure in Place [ J Tank/Pipe Repair ( ] Oxidizers: <br /> I,fTank/Pipe Removal [ J Re-excavation [)PCB's: <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART III <br /> Specific Site Information: / REQUIRED PERSONAL PROTECTIVE <br /> Tank No. 24 Tank Capacity: EQUIPMENT <br /> Tank Contents: Tank Age: <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> Type of Operation: 1�yD,4 ��,'JS ��� ��« unless appropriate rationale or restrictions are <br /> provided) <br /> Release History: 0–Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ ] YES ( ] 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: [ ] Other, specify: <br /> If monitoring instruments are not used, <br /> rationale or activity/area restrictions: <br /> Potential Health and Safety <br /> Physical Concerns: (check all that apply & describe) <br /> -eat or Cold Stress: of (high ambient temp.) <br /> ( 2. Personal Prolective Equipment <br /> Noise Source: <br /> ( ] Oxygen Deficiency: Level f Protection: [ ]A [ ]B ( [ ]D <br /> [„jcFvation: (falls, trips ,slipping, cave-ins) ( d hat <br /> [ ] Handling and Transfer of a Hazardous Substance: J,]--Safery glasses/goggles <br /> (fire, explosions, etc.) []'Steel toed/shank shoes or boots <br /> ( J Confined Space entry: (explosions) ( ] Flame retardant coveralls <br /> (�eavy equipment (physical injury & trauma resulting eating protection <br /> from moving equipment) yvek _ <br /> (r�espirator, circle: APR} or CBA <br /> [ J Other, specify A/P cartridge: _- <br /> [ J Safety vest <br /> Anticipated Biological Hazards: ( J Two-way communication <br /> ( Hakes;- ( ] Insects [�ents [ ] Poisonous Plants <br /> ( ] Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by: j Date: <br /> Plan Approved by:'_ _ Date:GC / <br /> l <br /> 12 <br />