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SA—N JOAQUIN COLit-1 i-Y ENVIRONN(ENTAL HEALTH <br /> S ITE HEALTH AN D SAF ETT Y P LAIN <br /> T I P.A.RT f I <br /> .Rx1L Sii- 1N'r0RM1%*ZON EVALUATION OF P=-N–IIAL. F—ARDS <br /> ice Name: / 6�1 1. C: m(cals ;Hazards <br /> ddress: �l (carcinogens- <br /> ^ <br /> onPerson: (]on: Phone No.6yUv (j Goeasives: <br />.vee?s number. / iZ/ [► L u: <br />�oPosed Date of investigacion/insoection: Z 7/ (�^'cplosives: <br /> ( ..mables• <br /> esc-iocion and brief narrative of inspecdon ac�vic. ( j 'norganic Gases: <br /> J N U. t Installation ( ] UAR Investigation ( Metals: <br /> J ank C;osure in Place ( J Tank/?ipe Re?air ( ] Oxidizers: <br /> Tank/?ipe Removal [ J Re-excavac:on [I PCB's: <br /> j Installation of 3orings/Monitor-ing Wells <br /> PART III <br /> pecific Site Information- 7� REQUIRED PERSONAL PROTEA <br />,ank No. Tank Capacity: U U V EQUIPNE� <br /> ank Contents: Tank Age: Ll—.(l/ <br />[her: 1. Monitoring Equipment: (note: Monitoring <br /> Q U <br /> instruments must be used for all operations <br /> Al'a of Operation: unless/appropriate rationale or res=ctions are <br /> proy�ded) <br /> Blease Historf [ Combustible Gas/Oxygen Meter <br /> ridenc_ of leaks/soil contamination: ( [ J NO ( J Detector Tubes (Specify) <br /> ocumented Groundwater contamination: [ ( I NO [ J Photoionizacion Detector <br /> ac`.tg-ound and des -ip ion of any Previous invesagadon [J Organic Vapor Analyzer <br /> ncide.^.ce: [ ] Other, specify: <br /> If monitoring irscrurnents are rot used, <br /> rationale or acwricy/area resc-:cnons: <br /> otent' 1 Health and Safecr <br /> h'; ' Concens: (check all that apply & desc--ioe) <br /> i ac or Cold Stress: or (high ambient temp.) j <br /> noi�Source: 2. Personal Protective Equipment <br /> J /gen Deciciency: Level,of Protection: ( IA [ IB [ IC [� <br /> avacion: (falls, trips ,slipping, cave-ins) CLYFard ac <br /> ,'ardling and Transfer of a Hazardous Substance: ( ikSa ec/ glasses/goggies <br /> (fire^explosions, ecc.) (keel ed/shank shoes or boots <br /> ICe <br /> nnned Space envy. (explosions) ( J r 6 e retardant coveralls <br /> rleavy equipment (physical injury & trauma resulting ( earing protection <br /> from moving equipment) ( ] Tyvek <br /> ( J Respirator, circle: APR or SC3A <br /> J Other, specify A/P carcidge: <br /> ( J Safety vest <br /> nticipated Biological Hazards: ( J Two-way communication <br /> J Snakes;• ( J Insects ( I Rodents ( J Poisonous Plants <br />] Other/Unknown (speciry): PART IV <br /> P"N APPROVAL <br /> far-alive (provide all information which could impact Healdi 7 <br /> id Safer/, e.;., power lines, integric/ of dices, terrain, etc.): Plan Prepared by: Date: C� <br /> Plan Approved by-' Date: <br /> 12 <br />