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a <br />SAN JOAQUIN COUNTY aNVIRONMENI TTAL HEALTH DIVISION <br />SITE HEALTH AND SAFETY PLAN <br />PART I PART II <br />GENERAL SIZE INFORMATION EVALUATION OF POTENTIAL HAZARDS <br />1. Site Name: 1. Chefnicals Hazards <br />Address: ( Carcinogens - <br />Contact Person: t111,_r Phone No. 6,3-7.3 -1161( ( ] Corrosives: <br />Sweeps Number. 7_5 f Z G [ ] Dusts: <br />Proposed Date of investigation/inspection: (] Iosives: <br />Flammables• <br />2. Des prion and brief narrative of inspection activity { ] Inorganic Gases: <br />D,rNew UST Installation [ ] UAR Investigation [ ] Metals: <br />[ ] Tank Closure in Place [ ] Tank/Pipe Repair [ j Oxidizers- <br />Cp]lank/Pipe Removal (J Re -excavation C PCB's: <br />(] Installation of Borings/Monitoring Wells <br />PART III <br />3. Specific Site Information: REQUIRED PERSONAL PROTECTIVE <br />Tank No./ -pl-D4 Tank Capacity: /0,00 -+ �`p`� EQUIPMENT <br />Tank Contents: 644&,.f p; ep Tank Age: <br />Other: 1. Monitoring Equipment: (note: Monitoring <br />/� instruments must be used for all operations <br />?. Type of Operation: Carte unlessppropriate rationale orrest+ictions are <br />pro ed) <br />S. Release History [ Combustible Gas/Oxygen Meter <br />Evidence of leaks/soil contamination: YES (] NO [ ] Detector Tubes (Specify) <br />Documented Groundwater contamination: [ ] YES ( 0 [ ] Photoionizarion Detector <br />Backg ound and description of any previous roves 'gation [ ] Organic Vapor Analyzer <br />or incidence: X11 o1n'_ tc� - [ ] Other, specify: <br />If monitoring instruments are not used, <br />rationale or activity /area restrictions: <br />6. Potential Health and Safety <br />Phys' al Concerns: (check all that apply & describe) <br />( or Cold Stress: of (high ambient temp.) <br />[ 640ise Source: 2. Personal Protective Equipment <br />(] 0 gen Deficiency: Lev of Protection: [ ]A [ ]B [ ]C <br />( cavation: (falls, trips ,slipping, cave-ins) Leve <br />hat <br />[ Handling and Transfer of a Hazardous Substance: [tel s ery glasses/goggles <br />(fire, explosions, etc.) PJSteel toed/shank shoes or boots . <br />[ ] <br />Confined Space entry: (explosions)retardant coveralls <br />,eavy equipment (physical injury & trauma resulting [ ear <br />protection <br />from moving equipment) [ j Tyve-k <br />( ] Respirator, circle: APR or SCBA <br />[ ] Other, specify A/P cartridge: <br />[ ] Safety vest <br />7. Anticipated Biological Hazards: [ ] Two-way communication <br />( I 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. i7 L,-- Date: <br />Plan Approved by: a Date--� <br />E'r-23081 (2/7/92) <br />