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Or I jVP <br />SAN TOAQUIN COTJ= E:V-YMONT rf�N+'I AL, EMAL.TH DrVISION <br />SITE FI AL.TH A ND SAFE= PT --A. <br />PART I <br />GENERAL SITE ! FORMA.TION <br />r <br />.. Site Mame: <+ <br />Address: <br />Cont-P+'rsoII' Phone No. R <br />Sweeps Vumoe _ 767 <br />Proposed Date or 1297 <br />2. Desc_iption and brief taarrarive of inspection ac^vi. <br />),(New UST incraliaroa (j UAR IIIvest:gatioa <br />j Tann C:osure a Place (j Tank/Pipe Repair <br />. a k/Pipe Removal (j Re-�scavIto <br />a <br />[ j installation of Bor ngs/Moaitoring Wells <br />3. Soec=+-c Site In-*ot3atro= <br />Tank No. I Tank Capacty / ®/ 10 <br />Tank Contents: Tank Age: <br />Other: <br />c <br />1 ype of Operation: <br />V 2f - <br />S. Rei ease �-sroryr <br />,ridence of leaks/soli conrantinarion: (j MS NO <br />Documented Groundwater commnunadon: [ j "MS : O <br />Bac`{;round and des(=mdcn of any Previous investigation <br />or incidence: <br />5. Pocendal Health and Saze_ry <br />Physical Concemms: Cc :ens: ail that apply & desc:De) <br />Hear or Cold Stress: °�' Chigdi ambient tarp.) <br />Voise Source.' G . ®C <br />(j Oxygen Dedcercy: <br />E avadon: (fails, m -ms ,Supping, cave -IIIc) <br />Handling and Transfer- of a Hazardous Subscncce: <br />(are, e=iosions, eec.) <br />( I Condaed Soace enry: esgiosions) <br />Heavy equipment (phpsicai injury & trauma ting <br />iom moving <br />[ j Other, specify <br />7. Anticipated Bioiogic: i ca=rds: <br />[ j Snakes ( I Insects C j Rodents (j Poisonous Plants <br />1 Odier/Unknown (sveciv): <br />8. Starr alive (provide all inforiation whit z could impacz Health <br />and Safety, a.;, Power lines, iaregy of duces, ce^ala, etc.): <br />E.H13081 (2/7/92) <br />PART B <br />EVALUAZION OF POTMMAL FIAT.ARDS <br />?ART 01 <br />REQTJMD PV—RSONAL MOTE= <br />EQUIPMEN T <br />?. Monitoring E'auipmenz+ Cnote: Moniroem,- <br />m. s—...:me=m must, be Used for ad operations <br />unless worouriate:ar.'oIIaie or=es=--c^ons are <br />nro 'ded) <br />Combustible Gas/Oxygen Metes <br />( j De*te=or Tubes CSoecifp) <br />[ j Phoroionization De=cor <br />( I Organic Vapor A.naiyzer <br />C I Other specitj: <br />If s onitor�ng inz=,mrents are pat aced, <br />mdonaie or acdr-ri /u--- <br />2. <br />area <br />2. Personal protective Equipment <br />La-ve-I of Protection: C Ia C IB C IC AD <br />"3rd bat <br />afery Siasses/;og,es <br />eeei coe& hank shoes or boots <br />C I Rame retardant cove -rails <br />cie=:�mz Proton <br />C I T7vek <br />(j Rwpuaror, csCe: APR or SC3A <br />A/P car,—. -d -,e: <br />Safety vest <br />[ I Two-way cormnunicar on <br />PAR. iV <br />PLAN APPROVAL <br />Prat Prepare: b ' :,are: <br />Plan Approved by. ' . A lI Date <br />C <br />