Laserfiche WebLink
SAN JOAQUIN I!OUNTY ENVIRONMENTAL HEAt-fH il VISION <br /> SITE HEAL'T'H AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTEN'T'IAL HAZARDS <br /> 1. Site Name: LP4 se 5/��ce_ 1. Che s Hazards <br /> Address: �dvi Carcinogens: <br /> Contact Person:_ZZx- Phone No. P•_`)3- [] Corrosives• <br /> Sweeps Number. / Srs 7 [ ] Du <br /> Proposed Date of investigation/inspection: [ �= <br /> j ammables• <br /> 2. Description and brief narrative of inspection activity: [ J Inorganic Gases: <br /> [ ] New Installation [ ] UAR Investigation [J Metals: <br /> ( J <br /> Talik Closure in Place [ ] Tank/Pipe Repair [] Oxidizers: <br /> [ ank/Pipe Removal [ ) Re-excavation [)PCB's: <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART III <br /> 3. Specific Site Information: `REQUIRED PERSONAL PROTECTIVE <br /> Tank No./y37- U/ Tank Capacity: /0/00 090 C,-e EQUIPMENT <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: unless a opriate rationale or restrictions are <br /> pro ' d) <br /> S. Release History: [ Combustuble Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ ] YES [ NO (] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES [q fqO [ ] Photoionization Detector <br /> Background and description of any previous investigation [] Organic Vapor Analyzer <br /> or incidence: - [ ) Other, specify: <br /> 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 /> [ ] Heat or Cold Stress: OF (high ambient temp.) <br /> [ J S 'ce: 2. Personal Protective Equipment <br /> [ en-Deficiency: ;„ nl�- Level of Protection: [ ]A [ ]B [ ]C [ ]D <br /> [ avation: (falls, trips ,slipping, cave-ins) [] Hard hat <br /> [ Handling and Transfer of a Hazardous Substance: [ ] Safety glasses/goggles <br /> (fire, explosions, etc.) [ J Steel toed/shank shoes or boots <br /> [ ) Co ed Space entry: (explosions) [ J Flame retardant coveralls <br /> (4-Meavy 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 Biological Hazards: [ ) Two-way communication <br /> [ J 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, terrain, etc.): Plan Prepared by Date: <br /> Plan Approved by: Date: �9 <br /> 12 <br />