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SAN JOAQUIN COI`1i ENVIRONMENTAL HEALTiISION <br /> SITE HEALTH AND SAFETY PLAN <br />�R� PART I I <br /> iN SITE INFORMATION EVALUATION OF POTENTIAL. HAZARDS <br /> Site Name ����/(I_����/���i�� 1 C>nlfcals Hazards <br /> Address �.- n Carcinogens <br /> Contact Person �Fj/-r rW,4,4C Phone No 368,� Corrosives <br /> Sweeps Number ( ] D sts <br /> Proposed Date of tnvestigation/inspection: O losives <br /> [I Flatnmables <br /> Description and brief narrative of inspection activity ( ] Inorganic Gases <br /> { ] New UST Installation [ J UAR Investigation [ J Metals- <br /> ( J TT k-Crsure to Place [ J Tank/Pipe Repair [ ] Oxidizers ; <br /> { ank/Pipe Removal [ ] Re-excavation (] PCS's <br /> [ ] Installation of Borings/Monitoring Wells <br /> PART ILL <br /> Specific Site Information REQUIRED PER.SONAL PROTECTIVE 3 <br /> Tank No Tank Capacity- b EQUIPMENT <br /> Tank Contents o f;m L_ Tank Age j <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 /> pro ded) <br /> Release History StCombustible Gas/Oxygen Meter <br /> Evidence of leaks/soil contamination [ ] YES [ ] NO [ ) Detector Tubes (Specify) <br /> Do ented Groundwater contamination [ ] YES ( ] NO ( ] Photoionization Detector <br /> Ba and and description of any previous investigation (] Organic Vapor Analyzer f <br /> or incidence ( J Other, specify- <br /> If <br /> pecifyIf monitoring instruments are not used, <br /> rationale or activity/area restrictions <br /> 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 />( ] Oxygen Deficiency Level of Protection ( ]A [ ]B [ ]C [�-- <br />( xcavation. (falls, trips ,slipping, cave-ins) [. and hat <br /> [ ] Handling and Transfer of a Hazardous Substance ( Safety glasses/goggles <br /> (fire, explosions, etc) [ eel toed/shank shoes or boots <br /> [ ] Confined Space entry- (explosions) [ J Flame retardant coveralls <br />(.Jeavy equipment (physical tnjury& trauma resulting VrIgTeanng protection <br /> from moving equipment) (,r i'yvek <br /> (aspirator, circle R or SCBA <br />[ ] Other, specify A/P cartridge C !¢ /k <br /> [ ] Safety vest <br /> Anticipated Biolo al Hazards* [ ] Two-way communication <br />[ J Snakes, insects [ ] Rodents [ ] Poisonous Plants <br />�( ] Other/Unknown (specify) PART IV <br /> PIAN APPROVAL <br /> Narrative (provide all information which could impact Health <br /> and Safety, a g, power lines, integrtry of dikes, terrain, etc)• Plan Prepared by Date 6A(a� <br /> Plan Approved by A Date ([ <br /> 12 <br />