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SAN JOAQLTIN COUNTY ENVIRONS-T L IISAL T" DIVISION <br /> SITE HEALTH AMD SAFETY PLAN <br /> PART II <br /> PART I EVALUATION OF POTBI AL HAZARDS <br /> GENERAL SITE INFORMATION r n <br /> 9 UJ ( r`Z S�Q 1. Chemicals Hazards <br /> 1. Site Name: f L] Carcinogens: <br /> ^r 6r [] Corrosives: <br /> Conrad Person ?hone No. v 11 � '—' <br /> Sweeps Number: / /L ( ] Explosives: <br /> Proposed Date of invesrigarion/inspe^ " , 17 [] Fiammables: <br /> / [ ] Inorganic Gases:Description and brief narrative of�tioa activity [j Metals* <br /> L I New UST Installation [I VAR Invesagarion ( I Oxidizer <br /> ( ) Tank Closure n Place L I a Pe Repair L I PCTS, <br /> Re-excavation <br /> Tank/Pipe Removal L I - <br /> [ ] Installation of Borings/MonitOri=9 'tells PART III <br /> 2 REQUIRED PERSONAL PROTECTIVE <br /> 3. Specific Site Information: d 0 0 6� EQ�ygNr <br /> Tank No. �� -L Tank Capacity: <br /> Tank Contents• � 'v S2/� Tank Age 1• Monitoring Equipment: (note: Monitoring <br /> Other. _ instruments must be used for all operations <br /> �G�(�/� r unless appropriate rationale orre=c:ions are <br /> 4. Type of Operation provided) <br /> [ ] Combustible Gas/Oxygen Meter <br /> 5. Release History. [] Detector Tubes (SPec fY)�— <br /> Evidence of leaks/soil conramernation [ I YES [ N [ j Photoionization Detector <br /> Documented Groundwater comam-itO adon: [ I YES L c Vapor Analyzer�- <br /> Background and description of any Previous investigation L I �� P <br /> [ 1 Other, specify. <br /> or incidence: if monitoring insa'umentsare not used, <br /> rationale or activity/area rest<ic'iors: <br /> b. Potential Health and Safety <br /> physical Concerns: (check all Thar apply & descibe) <br /> [ ] Hear or Cold Stress: °? Cbigh ambient temp.) <br /> Z Personal Protective Equipment <br /> [ ] Noise Source: of Protection: [ ]A [ IB [ 1C [� . <br /> ( ] Oxygen Deficiency: Hard Sat <br /> [ ] Excavation: (falls, trips slipping, cave-cis) [ ] giasses/goggies <br /> L I Handling and Transfer of a Irazardour Substance: t� Steel toed/shank shoes or boots <br /> (fire, explosions, etc) [ ] Flame retardant coveralls <br /> [ ] Confined Space entry Cexplosrous) <br /> [ I Heavy equipment (physical ajt^y&trauma resulting Hearing Protection <br /> L I <br /> Trek <br /> from moving equipment) [ ] Respirator, circle: APR or SC3A <br /> A/P cartridge: <br /> [ ] other, specify [ J Safety vest <br /> [j Two way communication <br /> 7. Anticipated Biological Hazards: poisonous Plana <br /> [ ] Snakes L l Insects [ ] Roden s L l PART IV <br /> [ ] other/Unknown (specify): PLAN APPROVAL <br /> 8. Narrative (provide all information wnich could mpact Health ?Ian Prepared by:/1i tjG <br /> and Safety, a g., power lines, integ�y of dikes, terrain, etc): <br /> Dau z�� <br /> plan Approved by. _---y <br /> ET-..23081 (2/7/92) <br />