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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DMSION <br />SITE HEALTH AND SAFETY PLAN <br />PART I PART II <br />GENERAL SITE MORMATION EVALUATION OF POTENTIAL HAZARDS <br />1. Site Name: Ala- lUnal gdv/,zF/511. Chemicals Hazards <br />Address: 2050 W > �r...� —� [lC cinogens: <br />Contact Person: 6 V Phone No. - b v2' [ ] ¢ olives: <br />Sweeps Number. I I [rr�JJ <br />Proposed Date of investigation/inspection: G/U4 i� [ losives: <br />[ Flammables: <br />2. Description and brief narrative of inspection activity: (] Inorganic Gases: <br />[ ] <br />Ne <br />,*'UST Installation (] UAR Investigation [ ] Metals: <br />[ ] dank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br />(q'Tank/Pipe Removal (] Re -excavation [ ] PCBs: <br />[ ] Installation of Borings/Monitoring Wells <br />PART III <br />3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br />Tank No. 01 Tank Capacity: l 0V EQUIPMENT <br />Tank Contents: L Tank Age: <br />Other. 1. Monitoring Equipment: (note: Monitoring <br />n / instruments must be used for all operations <br />"4. Type of Operation: Vo h "L% (h • unles ppropriate rationale or restrictions are <br />pro ded) <br />S. Release History:INOO [ Combustible Gas/Oxygen Meter <br />Evidence of leaks/soil contamination: [ ] YES ( [ ] Detector Tubes (Specify) <br />Documented Groundwater contamination: [ ] YES [ ( ] Photoionization Detector <br />Background and description of any previous investigation [ ] Organic Vapor Analyzer <br />or incidence: I(I o A&AA1rwi [,,ia4 J"n P [ ] Other, specify: <br />If monitoring instruments are not used, <br />rationale or activity /area restrictions: <br />6. Pae Health and Safety <br />PhyyiSal Concerns: (check all that apply &describe) <br />P7 <br />eat or Cold Stress: [ Did of (high ambient temp.) / <br />[ Source: 2 Pers al Protective EquipmentD/ <br />[ ] en Deficiency: Lev of Protecrion: [ ]A [ ]B [ ]C <br />[ en <br />(falls, trips ,slipping, cave-ins) [ hat <br />LI/Handling and Transfer of a Hazardous Substance: [ afety glasses/goggles <br />(fire explosions, etc.) [ St el toed/shank shoes or boots <br />[ ] ed Space entry: (explosions) [ ] ame retardant coveralls <br />[ eavy equipment (physical injury & trauma resulting [4 Hearing protection <br />from moving equipment) [ ] 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: Date: <br />Plan Approved by: Date: <br />EE23081 (2/7/92) <br />