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• 0 <br /> SAY TOAQUIN COT-J= EWMONME:47AL I-MALTH DIVISION <br /> STI'E HEALTH AND SAFETY PLAN <br /> ?ART I ?ART a <br /> GENERAL SITE 1NFORMAZION EVALI=CN OF POTMT AL F-AZARDS <br /> L Site Name: BpAIk /'l'D 10 -. (Ass 1. Chemicals Fazards <br /> Address 5. Carcnagens: �( nl�F.iVE <br /> Coacacr?erson: R-d., GwzleLi Phone No. /-ej6/p I Corrosives: <br /> Sweeps Number: ( ] Du=: <br /> Proposed Date o2 nvesdgadon/inspecaoa: [.j'` ,lasives: <br /> (�j�-lanmables• '(�nsn�� <br /> 2. Descpdon and 'brief aarradve of inspecdon acdvic/: [ ] faar;anic Gases: <br /> ( ] New UST Srstzladon ( I UAR Invesdgar on C I Mems: <br /> .[ ] Tank Closure n Place ( I TanWPipe Repair C I Oxidize:-s: <br /> Vank mipe Removai C I Re—scavadon C 1 PGi's <br /> [ ] Installation of Borxgs/Moniroring Wells <br /> ?ART III <br /> 3..SoecEc Site L--for--ado= -_� RQUEP& D PQRSONAl PRO1rCIIVE <br /> Ta Lk No. Tank Capacity: 5 QQU[PME"TL <br /> Tank Contents: Tank.kgt <br /> Corer. 1. Monitoring Eauipmenc (nore: Mothtprn9 <br /> (� <br /> .=s--=enrs must be -sed for ail opeadons <br /> 4. Type of Ope adoru unless anuroarare adonaie or=es=cons are <br /> Provided) <br /> S. Release Hisror/ ()], Combusr.ale Gas/CX79-n Meter <br /> 2vidence of leaks/son conrarmimarion: � �� [ I NO C ] Dem=or Tubes (Specify) <br /> Docxmenred Groundwarer conmrrt�nadon: ( j NO [ ] Phorcioniz=don Detecar <br /> Background and descndon of ?revia=gadoa (I Cr;azuc Vapor?raiyze= <br /> or incidence: , . fie! C I Orher rveci&r. <br /> If moniror^g insc_ments are aoc sed, <br /> aconaie or acdvir//area res^c_ors: <br /> 5. ?ocendai Health and Safe_/ <br /> Physical Cance_-s: (clieck ail mar apply & descoe) <br /> ( ] �F ar or Cold Stress: °n (]nigh ambient cempJ <br /> Eel Oise Source: �1�C.kS�nn�t+,'dJry1EM�— 2_ Personai Prorecve E=ipmemr <br /> C ] 0?7,rgen De3cency: Lave' of Pmcecon: C IA C 1B C IC {/�b <br /> [ cavaaon: (falls, =*us ,jiiaDui& Q � <br /> 9e-ins) 4 1 and bar <br /> C I Fandling and Transfer of a "razamous Subsemce: C I Safety glasses/goggles <br /> (Ere, explosions, etc) (-.Stee-1 coed/stank shoes or boas <br /> [ I Co _ ed Soace ena-7: (exgiosions) C I ==aMe retardant coveralls <br /> [ avy equipment (pnynCai miury& Sauma resDlang C 1 Fearing procet`on <br /> =om moving -qui ent) (I Tyvek <br /> ( I gmpiraror, crde: APR or SC3A <br /> C I Other, specify A/? car=dge: <br /> (j Safery nest <br /> 7. AndciDared Biolog c! "razards: ( j Two-way commuaicdon <br /> ( I Snakes CInsecs �Rodens [ I Poisonous Plans <br /> ( I Orher/Un_ awn (speciy): PART IV <br /> PLAN APPROVAL <br /> 8. Naradve (provide ail informacon which could impact Health <br /> and Safety, e.g., power lives, faregrir7 of dntes, :--min etc): Ran Prepared bar Cate: Z� <br /> Plan Approved by.�_ Date. <br /> 23081EIH (2/7/92) <br />