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SAS( JOAQUIN COUNTY ENVIRONN ENTAL !- A-k I-I DIVISION <br /> SITE HEALTH AND SAFETY PLkNi <br /> PART I PART II <br /> GENERAL. SITE INFORMATION LL II EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: ' 7 Y 1. Chemicals Hazards(� <br /> Address: t/,� 1f� �. { 1 t.%„y �QCarcinogens: LQ t �QL9.Qi <br /> Contact Person: Phone No. [] Corrosives: <br /> Sweeps Number. XDusrs: .t/_!YVV f c-.-n L �/X/ni✓¢�,`�y� <br /> Proposed Date of investigation/inspection: / V f. [ ] Explosives,. <br /> [] Flammables: <br /> 2. Description and brief narrative of inspection activity: ( ] Inorganic Gases: <br /> [ ] New UST installation [ ] UAR Investigation ( ] Metals: <br /> [ ] Tank Closure in Place I 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: ti REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity: 7 DO 1 6 DO 92f EQUIPMENT' <br /> Tank Contents: M,+n v!law C-Ce- Tank Age: SO J <br /> Other: fi—"-��— 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: Ong L t t, S fdCA`6Lj,, pct 0y, unless appropriate rationale or restrictions are <br /> TO l `t O provided) <br /> S. Release History: �Q,Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ ] YES [ ] 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: ll,i, rv�" [ ] Other, specify: <br /> If monitoring instruments are not used, <br /> rationale or activity/area restrictions: <br /> 6. Potential Health and Safety <br /> Ph ical Concerns: (check all that apply & describe) <br /> Heat or Cold Stress: of (high ambient temp.) <br /> Noise Source: 2. Personal Protective Equipment <br /> [ ] Oxygen Deficiency: Level of Protection: ( ]A ( ]B ( ]C KD <br /> Excavation: (falls, trips ,slipping, cave-ins) ,K Hard 'hat <br /> [ ] Handling and Transfer of a Hazardous Substance: -'Safety glasses/goggles <br /> (fire, explosions, etc.) _>4,Steel toed/shank shoes or boots <br /> [ ] Confined Space entry: (explosions) ( ] Flame retardant coveralls <br /> >k Heavy equipment (physical injury & trauma resulting Hearing protection <br /> from moving equipment) [ ] Tyvek <br /> [ ] Respirator, circle: APR or SC3A <br /> 6cT Other, specify 1 L A/P cartridge: <br /> />< [ ] Safety vest <br /> 7. Anticipated Bioiogical Hazards: [ ] Two-way communication <br /> [ ] Snakes [ ] Insects [ ] Rodents [ ] Poisonous Plants <br /> ( ] Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by- , ,-e.-)Date: 9-21J3 <br /> 77" o - wM CC �- Plan Approved by-. )I Date: <br /> EH23081 (2/7/92) <br />