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0 0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION 1 EVALUATION OF POTENTIAL.HAZARDS <br /> 1. Site Name: -71- 1. JC s Hazards <br /> Address: r56 u — 0Y / ogens: <br /> Contact Person: Phone No. G'az�f6 [ es: <br /> Sweeps Number: X28 —03 ( <br /> Proposed Date of investigation/inspection: C(/ri1L [ losives: <br /> [ limanic G <br /> 2. Description and brief narrative of inspection activity: ( ] organic Gases: <br /> [ ) N UST Installation ( ] UAR Investigation [ Metals: <br /> [ ] Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> [ Tanlc/Pipe Removal [ ] Re-excavation []PCB's: <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: � Q REQUIRED PERSONAL PROTECTIVE <br /> 00 <br /> Tank No. Tank Capacity: 0 EQUIPMENT <br /> Tank Contents: � Tank Age: V l!M <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instrume must be used for all operations <br /> 4. Type of Operation: �bY unless ppropriate rationale or restrictions are <br /> pro ' ed) <br /> 5. Release History: (,4/Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ ] YES [ ] NO [ ] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES [ ] NO [ ] Photoicnization Detector <br /> Background an description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: Y L'crxYWiry [ ] Other, specify: <br /> p{ w If monitoring instruments are not used, <br /> tis rationale or activity/area restrictions: <br /> 6. Pote al Health and Safety <br /> Ph Concerns: (check all that apply & describe) <br /> Hea or Cold Stress: of (high ambient temp.) <br /> [ is Source: 2. Person r tective Equipment <br /> [ ] 0 ge eficiency: Lev ]C [ <br /> Xn. (falls, trips ,slipping, cave-ins)and Transfer of a Hazardous Substance:osions, etc.) Steel toed/shank shoes or boots <br /> Space entry: (explosions) [ ] Flame retardant coveralls <br /> uipment (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): PART IV <br /> PIAN APPROVAL <br /> 8. Narrative (pro=erlines, <br /> on which could impact Health <br /> and Safety, a egrity of dikes, terrain, etc.): Plan Prepared by: Date: <br /> Plan Approved by: Date:li � <br /> EH23081 (2/7/92) <br />