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40 0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: �,�irio r /tL�i a��G�+ `lL% 1. Chemicals Hazards <br /> Address: [ Carcinogens: <br /> Contact Person:,/,lis 1Z r Phone No. 5T 3 -D, Yi [] Corrosives: <br /> Sweeps Number. Dusts: <br /> Proposed Date of investigation/inspection: [�fEzplosives: <br /> [f Flammables: <br /> 2. De ription and brief narrative of inspection activity. [ ] Inorganic Gases: <br /> [4 New UST Installation [ ] UAR Investigation [ ] Metals: <br /> ( ] ' nk Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> ( Tank/Pipe Removal [ ] Re-excavation []PCB's: <br /> ( ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br /> Tank No. 751-6 O4 Tank Capacity: EQUIPMENT <br /> Tank Contents: dXr2G�C Tank Age: <<' <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: unless appropriate rationale or restrictions are <br /> provided) <br /> S. Release History. ' [ ]'Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: (4YES [ ] NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: C ] 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 /> 6. Potential Health and Safety <br /> physical Concerns: (check all that apply& describe) <br /> ]� at or Cold Stress: of (high ambient temp.) <br /> [ Noise Source: 2. Personal Protective Equipment <br /> [ ] Oxygen Deficiency: Level of Protection: I ]A [ ]B ( ]C [ ]D <br /> (a'Excavation: (falls, trips ,slipping, cave-ins) [,] Hard hat <br /> [ ] Handling and Transfer of a Hazardous Substance: I ] Safery glasses/goggles <br /> (fire, explosions, etc.) I-Steel toed/shank shoes or boots <br /> [ ] fined Space entry. (explosions) [ ] Fame retardant coveralls <br /> ( eavy equipment (physical injury& trauma resulting 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): PARTIV <br /> PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of(likes, terrain, etc.): Plan Prepared by: sL Date: LO l y <br /> Plan Approved by: Date: <br /> EH23081 (2/7/92) <br />