Laserfiche WebLink
Corrosives: <br />Dusts: <br />in Explosives: <br />Flammables: <br />0 Inorganic Gases: <br />Metals: <br />CI Oxidizers: <br />PCB's: <br />PART IV - PLAN APPROVAL <br />Plan Prepared by: Wi AP,4 0-4A Date: 3/ fqr, <br />Date: 41 I R Plan Approved by: <br />SITE HEALTH AND SAFETY PLAN <br />PART I PART II I <br />GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br />Site Name: a4r C-0 itt- (>0-7,0 1. Chemicals Hazards <br />Address: (1 li ? osew---{A aArt- I maALI-e. CA _ n Carcinogens: <br />Contact Person: ) t.e-re, Phone No: 11-3 (4/7 I S <br />Sweeps Number: <br />Proposed Date of investigation/inspection: 3(1-491It <br />Description and brief narrative of inspection activity: <br />111 New UST installation. Li UAR Investigation. <br />Li Tank Closure in Place. 111 T ipe R ep ix:414 <br />Li Tank/Pipe Removal. <br />l <br /> <br />l Installation of Borings / Monitoring Wells. <br />3. Specific Site Information: <br />Tank No.: Tank Capacity: <br />Tank Age: <br />Other: <br />Type of Operation: Cow t.s.. <br />Release History: <br />Evidence of leaks / soil contamination: 0 YES 0 NO <br />Documented Groundwater contamination: 0 YES 0 NO <br />Background and description of any previous investigation or incidence: <br />PART III <br />REQUIRED PERSONAL PRI TECTIVE EQUIPMENT <br />1. Monitoring Equipment (note: Monitoring instruments must be used for all <br />operations unless appropriat rationale or restrictions are provided) <br />0 Combustible Gas/Oxyg Meter. <br />0 Detector Tubes (Specify). <br />Photo ionization Detect <br />0 Organic Vapor Analyzer. <br />Other, specify. <br />If monitoring instruments are not used, rationale or activity / area restrictions: <br />Tank Content: <br />2. Personal Protective Equipment <br />Level of Protection: OA OB 0 c 0 D <br />El Hard Hat. <br />Safety Glasses/goggles. <br />12ItSteel toed/shank shoes or boots. <br />CI Flame retardant coveralls. <br />CI Hearing protection. <br />CI Tyvek. <br />CI Respirator: 0 APR 0 SCBA <br />A/P cartridge: <br />EWafety vest. <br />6. Potential Health and Safety <br />Physical Concerns: (check all that apply & describe) <br />Li Hear or Cold Stress: °F (high ambient temp.) <br />CI Noise Sources: <br />El Oxygen Deficiency: <br />Excavation: (falls, trips, slipping, cave-ins): <br />Handling and Transfer of a Hazardous Substance: (fire, explosions, <br />etc..): <br />Confined space entry: (explosions): <br />111 Heavy equipment (physical injury & trauma resulting from moving <br />equipment): gt. Two-way communication. <br />CI Other, specify <br /> <br />7. Anticipated Biological Hazards: <br />Snakes T)Insects 0 Rodents 0 Poisonous Plants <br />Other/Unknown (specify): <br /> <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 (12/17/2002)