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SAN JOAQUIN COUNTY ENVJRONNIENTAL HEALTH DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> PART I PART II <br /> GENERAL SITE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br /> 1. Site Name: i O L— L...,-- 1. Ch icals Hazards <br /> Address: 7 ® / [ Carcinogens: <br /> Contact Person: E Phone No. 33 Corrosives: <br /> Sweeps Number: Z [ ] : <br /> Proposed Date of investigation/inspection: [kam=ables: <br /> losives: <br /> [ <br /> 2. Description and brief narrative of inspection activity: [ ] Inorganic Gases: <br /> [ ] New UST Installation [ ] UAR Investigation [] Metals: <br /> [ ] Tank Closure in Place [ ] Tank/Pipe Repair [ ] Oxidizers: <br /> LJ—Tank/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. 2 t Tank Capacity- iJ EQUIPMENT <br /> Tank Contents: Tank Age: L0`l,� <br /> Other: 1. Monitoring Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> 4. Type of Operation: unless appropriate rationale or restrictions are <br /> pro ° ed) <br /> 5. Release History: JT Combustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination: [ ] YES [ ] NO [] Detector Tubes (Specify) <br /> Documented Groundwater contamination: [ ] YES [ ] NO [ ] 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 /> [ ] Noise Source: 2. Personal Protective Equipment <br /> [ ] 9xygen Deficiency: Level of Protection: [ ]A [ ]B [-'C [IV <br /> [ xcavation: (falls, trips ,slipping, cave-ins) [ d hat <br /> [ ] Handling and Transfer of a Hazardous Substance: [150ety glasses/goggles <br /> (fire, explosions, etc.) [T Steel toed/shank shoes or boots <br /> [ ] Confined Space entry: (explosions) [ ] Flame retardant coveralls <br /> Heavy equipment (physical injury&trauma resulting [J-Hearing protection <br /> from moving equipment) ['rTyvek <br /> [ espirator, circle: APR or CBA <br /> [ ] Other, specify A/P cartridge: G / <br /> [ ] Safety vest <br /> 7. Anticipated Biological Hazards: [ ] Two-way communication <br /> [ ] 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: <br /> MH23081 (2/7/92) <br />