Laserfiche WebLink
SAN JOAQUIN COUNTY EWI;RONMEN7AL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART Ir <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name:�S�JtFr�PQr?g� Fj�� <br /> Address: I. Chemicals Hazards <br /> �� ��¢p�. a [] <br /> Carcinogens: <br /> Contact Person:rson:IdL�a Phone No. [I Corrosives: <br /> Sweeps Number. )(Dusts: <br /> Proposed Date of investigation/inspection: //'�'j— y5 [ ]'Explosives: <br /> ( ] Flammables: <br /> 2. Description and brief narrative of inspection activity. [] Inorganic Gases: <br /> [] New UST Installation [] UAR Investigation <br /> [] [I Metals: <br /> Tank Closure in Place <br /> [j Tank/Pipe Repair [] Oxidizers: <br /> [] Tank/Pipe Removal [] Re-excavation <br /> []PCB s•. <br /> [] Installation of BoringslMonitorinpg Wells <br /> LI NZ ItAASTM GENERR• TM, PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity: EQUIPMENT <br /> Tank Contents: Tank Age: <br /> Other. 1. Monitoring Equipment. (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: �[✓� , �}�y r unless appropriate rationale or restrictions are <br /> Q provided) <br /> 5. Release History: ( ] Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: RYES [] NO [I Detector Tubes (Specify) <br /> Documented Groundwater contamination: (] YES [I NO [I Photoionization Detector <br /> Background and description of any previous investigation [I Organic Vapor Analyzer <br /> iorincidence: 5 G7I Ova (I Other, specryIf monitoring instruments are not used,rd✓_ t �� trhP �: ai��..: D� 4 r� <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: M Ar f nw rLl 2. Personal Protective Equipment <br /> [I Oxygen Deficiency J - Levet of Protection: []A []B [ ICD <br /> [I fq�-. (falls, trips ,slipping, cave-ins) XHard hat <br /> [I Handling and Transfer of a Hazardous Substance: Safety glasseslgoggies <br /> (fire, explosions, etc) XSteel toed/shank shoes or boots <br /> [I Confined Space entry: (explosions) <br /> \ [] Flame retardant coveralls <br /> Heavy equipment (physical injury & trauma resulting \ >�Hearing protection <br /> from moving equipment) ror f< L1 JJJ (I Tyvek <br /> [] Other, specify [1 Respirator, circle: APR or SCBA <br /> A/P cartridge: <br /> `7. Anticipated Biological Hoards: NONE Safety vest[] Two-way communication <br /> [] Snakes [I Insects [I Rodents [] Poisonous Plants <br /> [] Other/Unknown (specify): PART IV <br /> 8. Narrative (provide all information which could impact Health PLAN APPROVAL n <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc): Plan Prepared b f'� Date: <br /> Tn c no <br /> Plan Approved by: fi I i Dare: <br /> G —"0 <br /> EH 081 (2/7/92) �� <br />