Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIROMMENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> eRT I PART II <br /> :4NERAL SITE INFOWMATION EVALUATION OF POTENTIAL HAZARDS <br /> Site Name: -Ro1. Chemicals Hazards <br /> Address: Carcinogens: <br /> Contact Person: Phone No. j (I Corrosives: <br /> Sweeps Number•. Dusts: <br /> Proposed Date of investigacion/inspection: (?—f ( ] Explosives: <br /> Flammables: <br /> Description and brief narrative of inspection activity: ( ] Inorganic Gases: <br /> ( j NewUST Installation ( } UAR Investigation Metals: <br /> ( J Tank Closure in Place ( J Tank/Pipe Repair [] Oxidizers: <br /> ( J Tan.WPipe Removal ( ] Re-excavation (J PCB's: <br /> [ j)hstallation of Borings/Monico ' g WeUs <br /> PART III <br /> Specific Sicenformatio REQUIRED PERSONAL PROTECTIVE <br /> Tank No. Tank Capacity: EQUIPMF-Tr <br /> Tank Contents: Tank Age: <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> Type of Operation: unless appropriate rationale or restrictions are <br /> provided) .' <br /> Release History: ( ] Combustible Gas/Oxygen Mecer <br /> Evidence of leaks/soil contamination: [ J YES [ J NO [J Detector Tubes (Specify) <br />;+ Documented Groundwater contamination: [ I YES [ J NO ( ] Photoionization Detector <br /> Background and description of any previous investigation. [J Organic Vapor Analyzer <br /> or incidence: [ Other, specify: 1® <br /> If monitoring instruments are not used, <br /> rationale or activity/area restrictions: <br /> Pocential•Health and Safety <br /> Physical Concerns: (check all that apply & describe) <br /> ( J Heat or Cold Stress: °F (high ambient temp.) <br /> Noise Source: 2. Personal Protective Equipment <br /> [ ] Oxygen DeficiencyLeve Protection: [ ]A [ JB [ JC [ }D <br /> [ j Excavation: alts ,slipping, cave-ins) ( d hat <br /> [ j Handling and ransfer of a Hazardous Substance: ( ry glasses/goggles <br /> (fire, explosions, etc.) U,,Steel toed/shank shoes or boots <br /> [ J Confined Space entry: (explosions) ( J FILAme retardant coveralls <br /> Heavy equipment (physical injury& trauma resulting earing protection <br /> rom moving equipment) C, ` l ( J Tyvek <br /> [ ] Respirator, circle: APR or SCBA <br /> [ } Other, specify Al? cartridge: <br /> ( ] Safety vest <br /> Anticipated Biological Hazards: [ ] Two-way communication. <br /> ( ] Snakes; [ ] Insects ( ] Rodents ( ] Poisonous Plants <br /> [ J Other/Unknown (specify): PART IV <br /> PLAN APPROVAL <br /> Narracive (provide all information which could impact Health <br /> and Safer/, e.g., power lines, integrity of dikes, terrain, etc.): Plan Prepared by. ' Date: f <br /> Plan Approved by: Dace: <br /> 12 <br />