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SAN IOAQU-Ili C0TJ-t= EN -&MN- '.kL. ,tMLUE Dr,=ON <br />SITE FMALL7H AND SAFETY PLA.NY <br />PART I PART IF <br />GEgERAL SZ7EE INFORMATION EVALUATION OF POTMiTIAL F- S <br />1. Site dame: 1. Chemicals Hazards <br />Address: [ I Carcinogens: <br />Contac: Person:s n— Phone No. f1 corrosives: <br />Sweeps Vber <br />urr: f I Dusts: t&&we1d>� <br />Proposed Date or invemgation/inspec:�oru [ j E cioszve§:C114 <br />C I =-aranzabies: <br />Z Description and 'brief narrative of inspection aczivi . [ j Inorganic Gases: <br />[ 1 New UST i + oa ( j UAR Investigation [ j Metals: <br />f I T ank Closure in Place ( j Tank/Pipe Repair [ j Oxidizers: <br />Tank/Pipe Removal [ 1 Re--= aion [ j PC3's: <br />I I Installation of 3orings/Moniroring Wells <br />PART UI <br />I Soe=-c Site Infoc3aeo= REQL= PERSONAL PRO• ECIIVE <br />rank No. ( Tank Capacity: EQUIP <br />Tank Conte—mrs• Tank Age: <br />Other L 1. moriroring Ecnupmena (note: Monitoring <br />=s.s".=e^= =usz, oe used rot' all operations <br />?. 1'fpe of Cper3L'on: u-Iess apOrOpt'.3Le:aL'Oame or.esT..c^ons are <br />providea <br />S. Release ;�iisror - >crCombuseble Gas/Oxygen Meter <br />e ridence or teaks/soli co n: [ j ''� NO [ I Dere-or Tunes (Soecity) <br />Documented Groundwater contamination: [ 17M NO (I Pinocoioniz_cian Decec or <br />Back round and des=ran or any previous =7esmgaton [ I Orgamc Vapor Asaiyze: <br />or inc:den A [ j Other, specif�r <br />If =oniroz-img irsa=e*= are aoc .sed, <br />rz=onale or acciv*�-/ /area resax-tons: <br />5. ?ocendal :wealth and Safe -^l <br />Ph�---ear <br />*ai Conc_**_s: Ccheck ail d= apoly & desc.,ne) <br />[ r Cold Stress: OF (izigti amnie= terp.) <br />[ jtse Source: _ I Personal Proce�ve Enupmerr <br />f I xygen Deficiency: _ Lave' of Protec-rion: [']A* f IB f IC AD <br />( cav doa: (.Faits, arcs ,Iiippim'- cave-ins) :^lar(' agar <br />C -T Handling and Transfer of a r' ous Substance:Safety gjasses/gog�es <br />(fire, exciosions, am ),$ Steri coed/shank shoes or boots <br />(j Conned Soace entry:(Ax_ iosions) f 1 Flame retardant coveralls <br />:=envy equipment (Physical #jury & anon- resulting e g grote--on <br />xM moving equipmenr) [ 1 Tyvek <br />® (j Resoir=r, circle: APR or SC3A <br />f I Other, specify A/P carz idge: <br />X,Saferry vest <br />7. Anticipaced Biological hazards: SIU [ I Two-way cor=unicmdon <br />f I Snakes ( j Insects ( I Rodents [ j Poisonous Plants <br />(I Other/UnLmowrn (specify): PART IV <br />PLAN APPROVAL <br />I Narrative (provide all information which could impar Health <br />and Safe^j, e.g., power Kaes, integ=er of dikes, :errz r, etc.): ?Pan pr�ared by'. Date: <br />Plan ?.poroved ay. Date. <br />E:H?308 i (2/7/92) <br />