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JOAQULN COU' T'YN =`+-VI�tO-RYL�- AI A]:,T_: DIti <br /> SIT <br /> HEALTH .4-\M SAFE= PLk Ni <br /> „R T PART II <br /> C_V'LAL Si=L INFORMATION LVALUA'nON OF POT?r"uAL HAZARDS <br /> _. Site `lase: 5.,1 Ei1Lm ) 1- Chemicals •razards <br /> Address: 1533 6 1 IuDSA"1 �.]�Carcn°ge s: <br /> COatac?_-son: rt,,nL llU.L�One N0. LrCorrnsives: <br /> Sweeps Number•. C J Dom- <br /> Pr000sed Date or svesli. On/insoecaon <br /> 2. Dseintion and 'oriel nz--adve of i=e-on ac3vfLy- [ I Inorganic Cases: <br /> [ 1 New UST instZeI:OII C J UAR investigation C I 'dam= <br /> [ ] Tank Closure in ?lace [ l Tank/Pipe Repair C l O=idizers: <br /> ( ] .an--/Pipe Removal C J +� L� C I PCB's: <br /> (] •,as2lation of 3origs/Mot:iroring <br /> ??RT IL <br /> Tc- <br /> 3. Soec_"c Site L--;Orlaeos REQUIRE P7—RSONPI.PROT=C M <br /> =rk N0. Tank C37ar-ry- FQlli!' lL <br /> dnk Coutencs: Taak Age 1. MOn1LOI'^g .- <br /> ='�1t,nDIIEP-C (note: �'IO 'L'COLin$ <br /> �,�` <br /> s�3e_^-= =usz Oe used for aL ope2nOrS <br /> y?e OC( pe2L OC unless at) rooeate znOIIak Orres=GODS ate <br /> orovided) <br /> S. R lease E_storl [ ] Combustible Cas/Ozyge^ Mete-- <br /> VAdence Of lea•'cs/saiil cor=inarion: [ I SS [I NO [ J Dete—r Tubes (SOe;s/) <br /> Dog =red Grot=awat°• con�iLatiOr: [ J C I NO ( I ?homion*zaron Detector <br /> 3actground and des=,vton of any Previous 'mvestigatioII [I O,zric Vapor -rziycer <br /> or aerie ce: [ 1 Other, specify. <br /> (f monftortm-ginszruz e-. are LOC _sea, <br /> ationale or acnvirl/area rs=c=ars: <br /> 5- Pore_^-Ltal Health and Sate-7 <br /> Physical concern-s: (chec-k aII Char apply & descbe) <br /> C l 'ear or Cold Stress: °? Cmc ambient temp.) 2 personal Proce-ve H=praent <br /> [ ] Noise Source: <br /> C I Orlgen Dedde=cl• Le or Prore= [ JA ( 13 CIC ( 1D <br /> [t�,2 d hat <br /> ( ] _cavaron (_`airs, S S11DDmg, cave-ins) KSare_ry gizsses/gogds <br /> M"Hznoling and of a Fmmrdous Substance: [. Stee_l. toed/shank shoes or coats <br /> (Le, eruiosiprs, ere) <br /> :lame retardantcoveralls <br /> Confined Soaren -1 (plosions) Hearing prorec_on <br /> �fHeavy emneme= (pcal i4jury& resuting <br /> ( ] Tyvek <br /> 8 ora moving Eu nmanr) <br /> ( ] Resoiraror, Qae: ?PR or SC3A <br /> [vYOv+ie , soecry LIN";QW N A/P c.=:dge. <br /> (vrSafery ver <br /> �wo-way corarmuniG'nOn <br /> 7. Anticipat•_d 3iologic.1 Hazards: <br /> ( j Snakes [ ] lOsecrs C l Rodents [ 7 Poisonous Plants peRT. N <br /> [�Orher/U� (spe=SY): PLAN APPROVAL <br /> S.\ oNa-carve (provide ail in:oanation which could Daae Heal L prepared Sy. d✓J DSI 2 ate 6 <br /> and Safety, ea, power Les, inregsy Of dies, to-min, atc-): <br /> plan Approved by. Date: <br /> E:-M3081 (2/7/92) <br />