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0 0 <br /> SAN JOAQUIN COUNTY ENVIRON1%1ENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: ky, T n , sur 1 1. Chemicals Hazards <br /> Address: \\34(e N 14 uQ 9 l_cx1` jd Carcinogens: �exzcwL <br /> Contact Person:is r �cns1�** Phone No. 931-600p []Corrosives: <br /> Sweeps Number: 2 3 II(o [ ] Dusts: <br /> Proposed Date of investigation/inspection: [fi Explosives: <br /> cgFlammables: C�asol,hz <br /> 2. Description and brief narrative of inspection activity. [ ] Inorganic Gases: <br /> [ ] New UST Installation [ ] UAR Investigation [] Metals: <br /> [ ] Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> ><ank/Pipe Removal [ ] Re-excavation []PCB's: <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Z31GZ-i -(0 Tank Capacity: 4,ocx� a l EQUIPMENT <br /> Tank Contents:Lt1 GGsTank Ager <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: l suck. unless appropriate rationale or restrictions are <br /> provided) <br /> S. Release History: Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ I YES 'KNO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES �d NO ( ] Photoicnization Detector <br /> Background and description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: [ j 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 /> Noise Source: me,rIACL \vti E 2. Personal Protective Equipment <br /> Oxygen Deficiency- Ong /an„,� o ,c}.FuY+ hp� Level of Protection: [ ]A [ IB [ ]C Y(f D <br /> Excavation: (falls, trips ,slip ing, cave-ins) ,Hard hat <br /> Handling and Transfer of a Hazardous Substance: i�j Safety glasses/goggles <br /> (fire, explosions, etc.) IL't l L /,IPr�( ,s i Steel toed/shank shoes or boots <br /> [ ] Confined Space entry: (explosions) [ ] Flame retardant coveralls <br /> 54_Heavy equipment (physical injury& trauma resulting Hearing protection <br /> from moving equipment) "C)C 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 dikes, terrain, etc.): Plan Prepared by: 1 \y\— Date:� /L4) 9'�— <br /> Plan Approved by: !t Date: <br /> EH23081 (2/7/92) <br />