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Sf1��I JOAQUIN COUNTY ENVIRONMENTAL HEAL. ,DIVISION <br /> SITE HEALTH AND SAFETY PLAN <br /> ART I PART II <br /> 1VIRAL SITE INFORMATIONEVALUATION OF POTENTIAL HA7rARDS <br /> _ . <br /> Site Name: L'E iE2S� / Lo . 1. Chemicals Hazards y <br /> Address: 577&'t' ry r Z ✓/GHQ C—carcinogens: <br /> Contact Person: /t* iC 0 Phone No G 1 1I Corrosives: <br /> Sweeps Number: - { } D sts: <br /> Proposed Date of investigation/inspection: [ osives; <br /> { ammables: <br /> ' .n In amc Gases: <br /> . Description and brief narrative of inspection activity: , .. � [ } ` <br /> [.] New UST Installation [ ] UAR Investigation _ erals: <br /> ( ] Tank Closure in Place [ } Tank/Pipe Repair [ ] Oxidizers: <br /> ,PI-T-ank/Pipe Removal ( ] Re-excavation _ [] PCB's: <br /> ( ] Installation of Borings/Moniroring Wells y - <br /> _ • PART FII s t <br /> Specific Site Information: ., REQUIRED PERSONA. PROTECTIVE' <br /> Tank Capacity- �� EQUIPMSENT k <br /> Tank No. P tY= - � <br /> Tank Contents: �L-aye-14 ( ,5:- Tank Age: <br /> Other: l:• Ivlonitoring.Equipment: (note: Monitoring <br /> instruments must be used for all operations <br /> tr <br /> Type of Operation: _ v � Y.�-per unless appropriate rationale or restrictions are <br /> Provided) <br /> Release History: - k-C—ombusrible Gas/Oxygen'Merer <br /> Evidence of leaps/soil contamination: [ ] YES [ I NO', ( ] Detector Tubes (Specify)„ <br /> Documented Groundwater contamination: [ 1 YES [ ] N0 [ ] 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: a <br /> Potential.Health and Safety <br /> Physical Concems: (check all that apply & describe) <br /> ( ] Hea or Cold Stress: of (high ambient temp.). 2. personal Protective Equipment <br /> LJ-Noise Source: Level f Protection: [ ]A [ ]B PIC 111 <br /> [ ] Oxygen Deficiency: A <br /> ( ] Excavation: (Falls, trips ,slipping, cave-ins) , rd hat <br /> Handling and Transfer of a Hazardous Substance: [ Saf ty glasses/goggles <br /> [ ] g Leel toed/shank shoes or boats <br /> (fire, explosions, etc.) <br /> [ ] Co ed Space entry: (explosions) (-]- F retardant coveralls <br /> ( eavy equipment (physical injury & trauma resulting { e ring protection <br /> [ ek p. � <br /> from moving equipment) ( espirator, circle: � r SCBA <br /> [ <br /> A/P cartridge: <br /> ] Other, specify G�tG� <br /> [ ] Safety vest <br /> Anticl , ed Biological Hazards: <br /> F [ ] Two-way communication = <br /> ] Insects ( ] Rodents [ ] Poisonous Planes PARTa <br /> { ] Other/Unknown (specify): N <br /> :PLAN APPROVAL: ' <br /> ;. Narrative (provide all information which could impact Health <br /> and Safety, e.g., power lines, integrity of duces, terrain, etc.): 'Plan Prepared by: -� Date: « `' <br /> Plan Approved b' Date: <br /> 12 u . <br /> x <br /> b <br />