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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE HEALTH AND SAFETY PLAN <br /> PART <br /> GENERAL SITE INFORMATION PART II <br /> 1. Site Name:Sumiden Wire EVALUATION OF POTENTIAL HAZARDS <br /> Address:1240 El Pinal I. Chemicals Hazards <br /> Contact Person: Phone No: Carcinogens: <br /> Sweeps Number: ,❑CC rrosives: <br /> Proposed Date of investigation/inspection: 10/19/04 ,,eDusts: O55! Y <br /> ❑Explosives: <br /> 2. Description and brief narrative of inspection activity: ❑Flammables: <br /> ❑New UST installation.. ❑UAR Investigation. ❑Inorganic Gases: <br /> ❑Tank Closure in Place.. ❑Tank/Pipe Repair. Metals: <br /> ❑Tank/Pipe Removal. ❑Re-excavation. ❑Oxidizers: <br /> ❑Installation of Borings/Monitoring Wells. ❑PCB's: <br /> Hazardous waste inspection ❑ Sampling <br /> PART III <br /> 3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tank No.: Tank Capacity: 1. Monitoring Equipment(note:Monitoring instruments must be used for all <br /> Tank Content: Tank Age: operations unless appropriate rationale or restrictions are provided) <br /> Other: ❑Combustible Gas/Oxygen Meter. <br /> ' <br /> El Detector Tubes(Specify). <br /> 4. Type of Operation: W)i ✓ �a`'rt u <br /> ❑Photo ionization Detector.. <br /> ❑Organic Vapor Analyzer. <br /> 5. Release History: ther,specify. <br /> Evidence of leaks/soil contamination: ❑YES ❑NO If monitoring instruments are not used,rationale or activity/area restrictions: <br /> Documented Groundwater contamination: ❑YES ❑NO .T <br /> Background and description of any previous investigate incidence: <br /> l /•� <br /> AJ* 2. Personal Protective Equipment <br /> Level of Protection: ❑A ❑B ❑C <br /> 6. Potential Health and Safety ❑Hard Hat. <br /> Physical Concerns:(check all that apply&describe) ETSafety Glasses/goggles. <br /> ❑Heat or Cold Stress: °F(high ambient temp.) eel toed/shank shoes or boots. <br /> ,2310-ise Sources: ❑Flame retardant coveralls. <br /> ❑Oxygen Deficiency: _p4earing protection. <br /> ,2"I`xcavation:(falls,trips,slipping,cave-ins): ❑Tyvek. <br /> ❑Handling and Transfer of a Hazardous Substance:(fire,explosions, ❑Respirator: ❑APR ❑SCBA <br /> etc..): <br /> A/P cartridge: <br /> ❑Confined space entry:(explosions): <br /> ET�Safety vest. <br /> ,L;Weavy equipment(physical injury&trauma resulting from moving <br /> ❑Two-way communication. <br /> equipment): <br /> ❑Other,specify <br /> PART IV-PLAN APPROVAL <br /> 7. Anticipated Biological Hazards: /Q /g /✓/ <br /> ❑Snakes ❑Insects ❑Rodents ❑Poisonous Plants Plan Prepared by: Date: <br /> ❑Other/Unknown(specify): <br /> Plan Approved by: Date: <br /> 8. Narrative(provide all information which could impact Health and Safety, <br /> e.g.,power lines,integrity of dikes,terrain,etc.) <br /> EH 23081(02/19/03) <br />