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i <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D SIGN <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART H <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: 114 14 r t —T,/n) L 1. Chemicals Hazards <br /> Address: _ ,],Carcinogens: <br /> Contact Person: p czu.(_, Phone No. ?0 Y /–O8� []Corrosives• <br /> Sweeps Number: ' �usts: <br /> Proposed Date of investigation/inspection: Or) [ ] Explosives: <br /> ,XFlammables: <br /> 2. Description and brief narrative of inspection activity: [ ] Inorganic Gases: <br /> [ ] New UST Installation [ ] UAR Investigation [] Metals: <br /> [ ] Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> [ ] Tank/Pipe Removal [ ] Re-excavation (]PCBs: <br /> [ ] I lation of Borings/Monitor�g Wells <br /> LJ Gf1 A S7`� 1416 tc1`l Ove PART III <br /> 3. Specific Site ormation: r REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity: EQUIPMENT <br /> Tank Contents: Tank Age: _ ,I <br /> Other: S r[ ���F' P�i'1 .0 C 1. Monitoring Equipment: (note: Monitoring <br /> – - instruments must be used for all operations <br /> 4. Type of-Operation ��/����(1_i�, �D A� -)am,(l('J unless appropriate rationale or restrictions are <br /> provided) &/t y o, <br /> 5. Release History: [ ] 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: L `` (. n [ ] Other, specify: <br /> If monitoring instruments are not used, <br /> rationale or activity/area estrictions: <br /> ` G <br /> 6. Potential Health and Safety <br /> Physical Concerns: (check all that apply& describe) u ', te��, <br /> [ ] Heat or Cold Stress: cF (high ambient temp.) Al 444.4 ro <br /> [ J Noise Source: 2. Personal Protective Equipment <br /> [ ] Oxygen Deficiency: Level of Protection: [ ]A [ ]B [ ]C 'KD <br /> [ ] Excavation: (falls, trips ,slipping, cave-ins) Hard hat <br /> [ ] Handling and Transfer of a Hazardous Substance: Safety glasses/goggles <br /> (fire, explosions, etc.) ASteel toed/shank shoes or boots <br /> [ ] Confined Space entry: (explosions) [ ] Flame retardant coveralls <br /> Heavy equipment (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 Biologic H ds: fu (ryLF_, [ ] 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, t , etc.): Plan Pre ared by: _ 'Date: <br /> c- <br /> = <br /> Plan Approved by', <br /> EH23081 (2/7/92) <br />