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F <br /> 4 - 1 <br /> SAN JOAQUIN COUNTNVIRONMENTAL HEALTH DI iSION <br /> SITE HEALTH AND SAFETY PLAN <br />,RT I PART II <br />,NERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> Site Name: 1. Che Gals Hazards <br /> Address: Zeoa lf 1-arcinogens: <br /> Contact Person: Phone No. O Corrosives: <br /> Sweeps Number. ( ] usrs: <br /> Proposed Date of investigarion/inspection: K E stves: <br /> [d-Rammables- <br /> Description and brief narrative of inspection activity: [ ] Inorganic Gases: <br />[ ] New UST Installation [ ) UAR Investigation [] Metals: <br />( ] Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br />['J Tank/Pipe Removal [ ) Re-excavation (]PCB's: <br />( ] Installation of Borings/Monitoring Wells <br /> PART III <br /> Specific Sice Info ation: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. 6 Tank Capacity Zi BOO 41:f;, EQUIPMENT <br /> Tank Contents: G(i Tank Age: n <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> Instruments must be used for all operations <br /> Type of Operation: 10WVObV 4AV� a1Lf 5 unless appropriate rationale or restrictions are <br /> provided) <br /> Release History, [+-Com bustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: OYES ( I NO ( ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES ( ] NO [ ] Photoionization Detector <br /> Background and description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: [ ] Other, specify: <br /> If monitoring instruments are not used, <br /> rationale or activity/area restrictions: <br /> Potential*Health and Safety <br /> Physical Concerns: (check all that apply& describe) <br />[ ] Heat or Cold Stress: of (high ambient temp.) <br />[ ] Noise Source: 2. Personal Protective Equipment '� <br />[ ] gen Deficiency: LeveLof Protection: [ ]A [ 1B P I� <br />[ Excavation: (falls, trips ,slipping, cave-ins) (iJ Hard hat <br />[ ] Handling and Transfer of a Hazardous Substance: [eS-, fety glasses/goggles <br /> (fire, explosions, etc.) [ Steel coed/shank shoes or boors <br />( ] fined Space entry: (explosions) ( ] F me retardant coveralls <br />[ Heavy equipment (physical injury & trauma resulting KHearing protection <br /> from moving equipment) [Kyvek <br /> [ espirator, circle: R o SCBA <br />[ ] Other, specify A/P cartridge: <br /> [ ] Safety vest <br /> Anticipated Biological Hazards: [ ] Two-way communication <br /> O Snakes.. (l rsects ( ] Rodents [/J Poisonous Plants <br />( ] Other/Unknown (specify): PARTIV <br /> PLAN APPROVAL <br /> Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by: —TI- Date: <br /> Plan Approved byi :c) Date: <br /> 12 <br />