Laserfiche WebLink
0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART 1 PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: t 1. Che icals Hazards <br /> Address: ( arcinogens: aasQ({iiF <br /> Contact Person: V>; (1 M Ro= Phone No. [] Corrosives: <br /> Sweeps Number: [ ] Dusts: <br /> Proposed Date of investigation/inspection: [ j Explosives: <br /> (yj�t lammables: 64, <br /> 2. Description and brief narrative of inspection activity: [I Inorganic Gases: <br /> [] New UST Installation [ ] UAR Investigation [ ] Metals: <br /> [ ] Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> (eank/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. _ °gym 31�a3,Tank Capacity: /o,e6c. 9 bEQUIPMENT <br /> Tank Contents: Tank Age: V=5 <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: k unless appropriate rationale or restrictions are <br /> prov ) <br /> 5. Release History: [ ombustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ ] YES ( 'N [ ] 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 /> 6. Potential Health and Safety <br /> Physical Concerns: (check all that apply & describe) <br /> [ at or Cold Stress: °F (high ambient temp.) <br /> Noise Source: 2. Personal Protective Equipment <br /> [F <br /> gen Deficiency: Leve ..of Protection: []A []13 [ ]C ;qD <br /> vation: (falls, trips slipping, cave-ins) Hard hat <br /> dling and Transfer of a Hazardous Substance: Vteel <br /> fety glasses/goggles <br /> (fire, explosions, etc.) toed/shank shoes or boots <br /> ] C refined Space entry: (explosions) [ j Flame 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 cartridge: <br /> [ 'safety vest <br /> 7. Anticipated Bi gical Haz s [j Two-way communication <br /> [ ] Snakes [ Insects WRodents [] Poisonous Plants <br /> [ ] Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> S. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by: F Date: / <br /> Plan Approved by: 'S�''J Date: � `� <br /> EH23081 (2/7/92) <br />