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% 60 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DMSION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE F iFORINIATIONEVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: G 1 t -Schad Uqct;,4. 1. Chemical Hazards <br /> Address: [carcinogens: <br /> Contact Person: Phone No. 3 Corrosives: <br /> Sweeps Number: []Dusts: <br /> Proposed Date of investigation/inspection: [J Explosives: <br /> `?flammables: <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 /> []Tank/Pipe Removal []Re-excavation [ ]PCB's: <br /> []Installation of Borings/Monitoring Wells <br /> 1 PART III <br /> C5� W' C�Zl1Qr�apr_ REQUIRED PERSONAL.PROTECTIVE <br /> fic S <br /> 3. peciite Information: <br /> Tank No. Tank Capacity: EQUIPMENT <br /> Tank Contents: Tank Age: <br /> Other: 1. Monitoring Equipment:(note: Monitoring <br /> um <br /> AA^ -�} instrents must be used for all operations <br /> 4. Type of Operation: I`K.�6�1 e�Gl�� G ?. • VAS unless appropriate rationale or restrictions are <br /> provided) <br /> 5. Release History: []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 []Organic Vapor Analyzer <br /> tr 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: °F(high ambient temp.) <br /> []Noise Source: 2. Personal Protective Equipment <br /> []Oxygen Deficiency: Le el of Protection: []A []B []C [4 <br /> [] xcavation: (falls,trips,slipping,cave-ins) [Vr�and hat <br /> V andling and Transfer of a Hazardous Substance: [y]'Safety glasses/goggles <br /> (fire,explosions,etc.) WSteel toed/shank shoes or boots <br /> [ ame retardant coveralls <br /> []Confined Space entry:(explosions) Hearing protection <br /> []Heavy equipment(physical injury&trauma resulting []Tyvek <br /> from moving equipment) <br /> []Respirator,circle: APR or SCBA <br /> cartridge: <br /> []Other,specify [ Safety vest <br /> 7. Anticipated Biological Hazards: <br /> []Two-way communication <br /> []Snakes []Insects []Rodents []Poisonous Plants PART IV <br /> []Other/Jnkno,,vn(specify): PLAN APPROVAL <br /> 8. Narrative(provide all information which could impact Health ^ P dyr44Date:��� <br /> 93_ <br /> and Safety,e.g.,power lines,integrity of dikes,terrain,etc.): Plan Prepared by:�c1�N' <br /> Plan Approved by: <br /> Date: <br /> EH23081 (2/7/92) <br />