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SAN JOAQUIN COUNTY ENVMONMENTAL F7FAT.TH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL. SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> i) �( 1. Chemicals Hazards <br /> 1. Site Name: Carcinogens <br /> Address: [] Corrosives <br /> Contact Person: Phone No.-- - 4900 <br /> Dusts: <br /> Sweeps Number [ I Explosives: <br /> Proposed Date of invesrigation/inspection: -f-- 15— >Plymrnables• n' <br /> 2. Description and brief narrative of inspection activity. [ ] Inorganic Gases. <br /> Metals: <br /> [ ] New UST Installation [ ] UAR Investigation qr� <br /> oxidizers: <br /> Tank/[ ] Tank Closure in Place [ ] Re-excavation <br /> Repair PCB?s <br /> `SKank/Pipe Removal [ ] Re-escavation <br /> ![ ] Installation of Borings/Monitoring wells PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity, :i_ -���boo EQUIPMENT <br /> Tank Contents: Tank Age: �' �}3'/� 1. Monitoring Equipment: (note: Monitoring <br /> Other: instruments must be used for all operations <br /> -rA kG unless appropriate rationale or restrictions are <br /> 4. Type of Operation: provided) <br /> Combustible Gas/Oxygen Meter <br /> 5. Release History Detector Tubes (Specify) <br /> Evidence of leaks/soil contamination: [ l YES [ ] NO L ] Photoionization Detector <br /> Documented Groundwater contamination: [ I YES [ I NO [ ]Organic Vapor Analyzer <br /> Background and description of any previous investigation 0� specify: <br /> or incidence: 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: >J-LQ—'F (high ambient temp.) <br /> 'Noise Source: L-' 2 Personal Protective Equipment <br /> en Deficiency: Level of Protection: [ ]A [ ]B ( lC `KD <br /> oxygen xyg XHard hat <br /> Excavation: (falls, trips ,slipping, cave-ins) Safety glasses/goggles <br /> ( ] Handling and Transfer of a Hazardous Substance: Steel toed/shank shoes or boots <br /> (fire, explosions, etc.) [ ] Flame retardant coveralls <br /> [ ] Confined Space entry: (explosions) Hearing protection <br /> je!Heavy equipment (Physical injury & trauma resulting Tyvek <br /> from moving equipment) L1 � K H nP <br /> Respirator, circle: APR or SOBA <br /> A/P cartridge: <br /> [ ] Other, specify >Y,9afety vest <br /> 7. Anticipated Biological Hazards: <br /> [ ] Two-way communication <br /> ( I Snakes [ I Insects [ I Rodents L l Poisonous Plants PART IV <br /> ( ] Other/Unknown (specify): PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health �.G� Date: <br /> rity <br /> and Safety, e.g., power lines, integof dikes, terrain, etc.): Plan Prepared b <br /> Plan Approved by Date: <br /> EH23081 (2/7/92) <br />