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y <br /> 3 <br /> Wt JOAQUIN COUNTY ENVI RO <br /> A HEALTH DIVISION <br /> sma mAL.Ta'A1V13 SAF "T'Y FLAN <br /> PART I PARiI`II <br /> CORAL SM MMALMON EVALUATION OF PO?BM&HAZARDS <br /> 1. Site Name: tj 7f a A. Chemicals Hazards <br /> Address; [l gens: <br /> Contact Pason: i' P w. J [I Corrosives: <br /> Sweeps Number: / <br /> Dusts <br /> Proposed Date of inspection: [] Explosivew <br /> [I Flammable::. <br /> 2. Description and brief narrative of inspection activity-, [] Inorganic Gases: <br /> [l New UST Installation [I UAR Investigation [I Metals' <br /> [l TjAc Closure in Place [I Tank/Pipe Repair {I Oxidizers: <br /> ank/Pipe Removal [I Re-ezcavation [I ms's: <br /> [I Installation of BorhMWMonitoring wells <br /> PART III <br /> 3. Specific Site Information: RRQUMED pERSOKA,PROTB+Cr= <br /> Tank,No. Tank Capacity �7._, 4 <br /> Tank Contents• Tank Age: <br /> Other 1. Monitoring Equipment (note:Monitoring <br /> ' !!__ instruments must be used for all.operations <br /> 4. Type of Operation: ,7 3 b� unless appropriate rationale orrearktio s are <br /> S. Release History: Combustible Gas/Ozygen Meter <br /> Evidence of leaks/son aination: [I YES [I NO [l Detector Tubes (Specify) <br /> Documented Groundwater contamination: [I YES [I NO (I Phota.ion Itctor <br /> Background and description of any previous investigation [l Organic VVwAnalyzer <br /> or incidence: [I Odor.spm, <br /> If monitoring instruments are tun used, <br /> rationale or activity/area restnctions: <br /> 6. Potential Health and Safety <br /> Physical Con cw= (check all that apply&describe) <br /> [I Heat or Cold Stress: ---2F No ambient gip.) <br /> [I Noise Source: L Personal Protective Equipment <br /> [ I Oxygen Deficiency: . of Protection: []A []B [IC �'ID <br /> [I Excavation: (fes, trips,slipping,cava-ins) ar hat <br /> [I Handling and Transfer of a Hazardoush-p <br /> S UC <br /> MMexplosions, etie.) toad/s�k shoes or boot <br /> [ Wgoggles <br /> l Confined Space antsy: (explosions)— [I Flame retardant coveralls <br /> [ l Heavy equipment(physipl injury&trauma resulting <br /> from mowing eqummtJ [I P <br /> [I Other,specify [I Respirator, circle: APR or SCBA <br /> A/P cartrridge: <br /> 7. Anticipated Biological Hazards: [I Sa tq vel <br /> [I Snakes [I Insects [I Rodents [I Poisonous Plants [I Tyro-way <br /> unica <br /> [I 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 brAd Date: G,•/– 'y <br /> Plan Approved by.- <br /> .Z2 Dau: <br /> EH2=1.QV7M <br />