Laserfiche WebLink
SAN JOAQU�T COUNTY ENlYMONMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> G&NERAL SITE INFORMATION EVALUATION OF PO'IMMAL HAZARDS <br /> 1. Site Name: lis. " = d E,rte 1_ C�lIp!dcats Hazards <br /> Address- cel Q -.!5. br,c ,t z <br /> Contact Person: Phone No. aS7-44 [I Corrosives: . <br /> Sweeps Number: [ j Dusts- <br /> Proposed Date of investigation/i aspection: 2D [ j ' osives: <br /> Damm a oles: <br /> Z. Description and brief narrative of inspection activity. [ j Inorganic Gases: <br /> [ I New UST Installation [I UAR Investigation [j Metals: <br /> [ ] Tek Closure in Place [ ] Tank/Pipe Repair (j Oxidizers: <br /> VTank/Pipe Removal [I Re-excavation [j PCB's: <br /> [ I Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Inr:b=arion: REQUIRED Pr_=NAL PROTECTIVE <br /> T ank No. Tank Capacity. EQUIPMENT <br /> Tank Contents: Tank Age: <br /> Other: U 1. Monitor'=g Equipment: (note: Monitoring <br /> instrumerrs must be used for all operations <br /> ?. Type of Operation: proy- <br /> ess a _ropriate:ationaie orrest*icyons are <br /> ed) <br /> S. Release History. Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil can 'on: [ j YES j NO [ I Detecror Tubes (Specify) <br /> Doc=nented Groundwater contamination: ( I YES -r j—NO [ I Photoionization Detector <br /> Background and description of any previous investigation [j Organic Vapor Analyze: <br /> or incidence: [ j Other, specify: <br /> If monitoring instr gents are not used, <br /> rationale or activity/area restrictions: <br /> 6. Potential Health and Safety <br /> Physical Conce_*n...s: (check all that apply& desciDe) <br /> [ j Hear or Cold Suess: °F (high ambient temp.) <br /> ' <br /> , Oise Source: '�C'J _ n � — 2 Personal protective Eauwment <br /> ( j Oxygen Deficiency: L�evel of Protection: ( IA ( IB CIC CID <br /> [�Excavarion: (fails, trips ,slipping, cave-ins) N hat <br /> ,K Handling and Transfer of a Hazardous Substance: � ty Biasses/goggles <br /> (fire, explosions, etc) ,Steel toed/shank shoes or boots <br /> n <br /> [ I Coned Space entry: (explosions) ( I Fi a retardant coveralls <br /> ^Heavy equipment (physical injury& trauma resulting nearing protection <br /> from moving equipment) - [I Tyvek <br /> [ ] Respirator, circle: APR or SOBA <br /> [ I Other, specify cart`idge: <br /> Safety vest <br /> i <br /> 7. Anticipated Biological Hazards: [ I Two=gray communication <br /> ( ] Snakes ecrs [dents (I Poisonous Plants <br /> [ ] <br /> Orher/Ur6mown (specs y): PART IV <br /> PLAN APPROVAL <br /> 8. Narrative (provide ail information which could impact Health <br /> and Safety, e.g., power lines, inteSTity of dikes, terrain, etc.): Plan Prepared by. Date: It <br /> Pian:approved by: i Dat�l� <br /> EH23081 (2/7/92) <br />