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SAN JOAQUIN COU!= E:`tVTRONiti�`+'I �I. IT��ITH DIVISION <br /> SITE EE-A .TH AND SAS PLA NL <br /> ?ART I ?ART 11 <br /> GF�NERAL SITE INFCRMAnON EVALUAnON OF POT"N'IIAL ILAZARDS <br /> i. Site Name: G v 57/*> I. Chemicals Hazards <br /> Address: �q-2 r eyvFA [I Car=ogeas <br /> Couacr Person: Phone No. C I Corrosives: <br /> Sweeps number /yG a7 C ] Dusa: <br /> Proposed Dare of=vestigatipa/mspecos gSj� lpsives: <br /> em-ammables. <br /> 2. Oesciption and brief aarradve of itmmection acviry. ( ] inorganic Cases: <br /> [ ) blew UST installation [ ] &AR r=vesCg=oa �bfemis <br /> C 7 Tank Cosure in Pace [ ] Tank/Pipe Repair <br /> CiJanic/Pipe Removal C j 3e—scavat:on C I PCB's: <br /> C j fnsallarf n of Borings/Mousormg Wets <br /> ?ART III <br /> 3. SoeciEc Sire Eformati REQURFD PERSONAL PRO' F_= <br /> Tank Yo. Tank Capaciry: /oIG Y3 + S�Sa EQUIPiTi <br /> TdII1C COnrz^r$: [.AS _'Q/ Tans Age: g:�e <br /> Crher•. Movicor-in. Eauipmeac (nom Ylar-frorng <br /> �-- �:metns mus, be used far ail operations <br /> 4. Type of Operation: 5�S S_r7A_r7AJ unless approoeare a -e <br /> ronaie ors=—=ons are <br /> orovidea� <br /> 5. Re ease F3sror/ Q�Combuscple Gas/Oxygen lferer <br /> _videvice of leaks sod conmraina^on: C j J S C I NO f l ereczor Tubes (59ecify) <br /> Doc=enced Groundwater conmroinnrion: f I 'Ms [ I NO [ j Phomioniz=doa Dececror <br /> Bacicgmtmd and desc�tioa of any Previous -vesagamoa C I Crganic Vapor Amaiyzer <br /> or incidence: C I Other, s?ecifY- <br /> fF=onirorag ivsc=ens are aoc used, <br /> rationale or ac=v r//area reser c_pvs: <br /> 5. ?acentiai Health and Safery <br /> Physical Canc_^s: (c'heer's ail mar apply& desa ibe) <br /> C ] 'Heat or Cold Stress: 13i 011911ar s:gyp.) <br /> ( oise Source. 2 Personal ?roceccive Fauipmenr <br /> [ II Oxygen Deficiency i•vel of Proreaos (IA C IB <br /> 'C.4_:_-cavation: (fails, ams siippirL ctve-ins) sd bar <br /> C I dandling and Transfer of a i-azardous Substance [ afety glasses/gagdes <br /> (Ere, emissions, etc) K Steel coed./shank shoes or boos <br /> ( I Confined Space envy: (explosions) C I Fame reardanr cove_-ails <br /> IM—eavy equipment (pa7mcai =jury& saunar nag Feartag prorecton <br /> tom moving --cm &Aare�.•E�f r t'Q,Tyv� <br /> s�tramr, circe- qr SOBA <br /> [ I Other, specify T A/P ca..=:dge: C% 7G—A) <br /> C I Seery vest <br /> i. Aaucipaced Biological -raards: C I Two-way communnicidon <br /> f ] Snakes C I Insects C I Roden= C I Poisonous ?!ova <br /> C 1 <br /> Other/Unknown (specify)' PART N <br /> PLAY APPROVAL <br /> I Narraave (provide ail informazi=which could impar Health <br /> and Safety, e.g., Power lives, inreg�f of d?ces, res=in, err): P!zr Pr pared Sy ier�F Data:/ <br /> Plan 1Dproved or. Dare: <br /> E:-L)3081 (2/7/92) <br />