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N: <br /> j cif a .,. <br /> Si-NIv JOAQUIN COUNTY ENVIR0NI+IENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAIN <br /> :T I PART II <br /> ,T-RAL SITE INFORMATION <br /> EVALUATION OF POTENTLAI. HAZARDS <br /> 'ire Name: I. Chemicals Hazards ' <br /> Adress: Z.D Co Carcinogens: eiyt gp�.t_p <br /> :antact Person: - one Na� �� �(o��7 (] Carrosives: <br /> weeps Number: �! 7 _ Dusts: <br /> 'roposed Date of investigation/inspecrion: Ex0.Iosives: <br /> FIaramables: I f it <br /> )escription and brief narrative of inspection activity: ( ] Inorganic Gases: <br /> lrNew UST Installation ( J UAR Investigation 41. .Me alt <br />�. J Tank Closure in Place [ J Tank/Pipe Repair ( j O:cidizers: <br /> <Tank/Pipe Removal ( J Re-excavadon (]PCB's: ! <br /> J Installation of Borings/Monitoring Wells :i <br /> PART III :l <br /> 'aecific Site Information: 6,jREQUIRED PERSONAL PROTECTIVE <br /> ank No. 16`-/ A .-e Tank Capacity ' �" ��p� EQUIPMENT ' <br /> ank Contents: a ` fbG_ ank Ase: <br /> )cher: I. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> ype of Operation: S unless appropriate rationale or restrictions are <br /> 901mbustible <br /> e,d) <br /> .elease History: Gas/Oxygen Meter <br /> ridence of Ieaks/soil contamination: [ ] YES [ ] NO [ j Detector Tubes (Specify) <br /> ocumented Groundwater contamination: [ J YES [ J NO [ ] Photoionization Detector <br /> ackground and description of any p evious investigation (] Organic Vapor Analyzer <br /> r incidence: [ I Other, specify: <br /> If monitoring instruments are not used, <br /> �`�. rationale or activity/area restrictions: <br /> �3 <br /> 'otential Health and Safety <br /> hysical Concerns: (check all that apply & describe) <br /> J Heat or Cold Stress: of (high ambient temp.) <br /> Noise Source: 2. Personal Protective Equipment d <br /> ] Oxygen Deficiency: Level of Protection: [ JA [ ]B 11C <br /> excavation: (falls, trips ,slipping, cave-ins) 1-K3ard hat <br /> Handling and Transfer of a Hazardous Substance: $<Safety glasses/goggles <br /> (fire, explosions, etc.) 'Steel toed/shank shoes or boots <br /> J Confined Space entry: (explosions) [ ] FIame retardant coveralls <br /> <Heavy equipment (physical injury & trauma resulting Hearing protection <br /> from moving equipment) ( ] Tyvek <br /> [ ] Respirator, circle: APR or SOBA <br /> ] Other, specify A/P cartridge: <br /> [ ] Safety vest - <br /> -anticipated Biological Hazards: /Vo-Ae- [ ] Two-way communication <br /> ] <br /> Snakes; [ J Insects [ ] Rodents [ ] Poisonous Plants <br /> ] Other/Unknown (specify): PART IV <br /> PLAN APPROVAL a <br /> Narrative (provide all information which could irnpact Health ,! a o <br /> _nd 5afery, e.g., power lines, integrtry of dikes, terrain, etc.}: Pian Prepaied by, Date: <br /> ou Plan Approved by --� Date: .. <br /> 12 <br />