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is gel <br /> SAN JOAQUIN COUN I Y ENVIRONME LEA TI-1 ✓1 VISION <br /> SITE HEALTH AND SAFETY <br /> PPART II <br /> ART I <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> r� <br /> n 1. Ch micals Hazards <br /> 1. Site Name: ftp-co [7arcinogens: <br /> Address: '� �'yI���Qf'` <br /> Phone No. (} Corrosives: <br /> Contact Person: [ ] Dusts: <br /> Sweeps Number: 4f ( ] Explosives: <br /> Proposed Date of investigation/inspection: [.4"Flammables: <br /> 2. Despniption and brief narrative of inspection activity: [ ] Inorganic Gases: <br /> [ UAR Investigation (Metals: <br /> New UST Installation [ ] Oxidizers: <br /> [ } T k Closure in Place [ ] Tank/Pipe Repair ( ] <br /> [ <br /> Re-excavation ank/Pipe Removal [ ] <br /> [] PCB's: <br /> [ ] Installation of Borings/Monitoring Wells PART III <br /> 3. Specific Site Informa ion: REQUIRED PERSONAL PROTECTIVE <br /> Tank Capacity: � � E tIIPMENT <br /> Tank No. '1 p ry: K �I-Id Q <br /> Tank Contents: 14-GA-5- Tank Age: I`'1 _ ± -i73 <br /> 1. Monitoring Equipment: (note: Monitoring <br /> Other: instruments must be used for all operations <br /> ASQ iQ� unless appropriate rationale or restrictions are <br /> 4. Type of Operation: provided) <br /> (+-C-o-mbustible Gas/Oxygen Meter <br /> 5. Release History: S NO [ ] Detector Tubes (Specify) <br /> Evidence of leaks/soil contamination: ( E ( } ionization Detector <br /> Organic Documented Groundwater contamination: ( ] YES (-]-NO ( ] <br /> Background and description of any previous investigation (] g ic iz Por Analyzer <br /> [ ] Other, specify: <br /> or incidence: 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 /> [Meat or Cold Stress: of (high ambient temp.) <br /> [,�oise Source: 2. Personal Protective Equipment <br /> oxygen Source: <br /> Deficiency: Level of Protection: ( ]A ( ]B ( ]C [-]Er <br /> ( ] xyg (4-Hard hat <br /> (excavation: (falls, trips ,slipping, cave ins) afe lasses/goggles <br /> [t,} Handling and Transfer of a Hazardous Substance: [� eel toed/shank shoes or boots <br /> (fire, explosions, etc.) [ ] Flame retardant coveralls <br /> [ } Confined Space entry: (explosions) [-]-Hearing protection <br /> [wavy equipment (physical injury & trauma resulting g <br /> Tyvek <br /> from moving equipment) [ ] Respirator, circle: APR or SCBA <br /> [ ] Other, specify A/P cartridge: <br /> [ ] Safety vest <br /> 7. Anticipated Biological Hazards: <br /> [ } Two-way communication <br /> [ ] Snakes; [ ] Insects [ ] Rodents [ ] Poisonous Plants PART IV <br /> ( } Other/Unknown (specify): PLAN APPROVAL <br /> 8. Narrative (provide all information which could impact Health plan Pre ared b Date: 5-70- 1 <br /> and Safety, e.g., power lines, integrity of dikes, terrain, etc.): P y' <br /> Plan Approved by: k Date: P) " v� <br /> 12 <br />