Laserfiche WebLink
i 0 <br /> JOAQULN COL-N i Y ENw RO?vmLViA: HEAL—LzIDIVISION <br /> SIT^. =-'-L?I•i AVDS?�=1Y ?La i <br /> PART i PART II <br /> ==AL =1 M INFORMA=ON EVALIIAMON OF PO.1_N MAL F'jAZARDS <br /> i. Site .Name: JoLLKP I &.4 Hay.... 1 e�eis 'r'z ds <br /> Address <br /> Conme?arson: Phone No. [j Cntz-osives: <br /> Sweeps Number [ ] Duns: <br /> Pr000sed Date pf zvesegado '=spe�pn ( ] ;losivs: <br /> 2. Dscodoa and brie=nz=aar ve of sspecdon ac=vire ( ] Iaorganic Cases: <br /> [ 1 New UST r, radon [ ] UAR lnveszg on xme+is: It k s L <br /> [ 1 Tank C asu.= = ?lace ( ] Tank/Pipe Revair ( ] Oji iz_^s: <br /> [ j -a^k/Pipe Re-oval ( ] Re-=ez7zzon [l PQ's: <br /> ( ] r^ aeon of 3or=gs/Monitoring Wells <br /> c PART M <br /> SiteFo: d= L�' � R`'.QTj= PE-RSONAL PROi=CTN <br /> r Vo. -z_k Capad-r. FQUi?bCT <br /> -an¢ Contents: Ta_k Aga. <br /> C'.the '_. Monitoring Eauir1me=C (note: Momiror-- <br /> ((��' ��.--��,,,, ,�,, q..(_ q(-� must be tsec :or all oDe_2nOr-s <br /> ;?e OC OpaZncm: J'''f'f�';<d�i IA&S V 1 A 1 OM C^.iess aDDrJLI:.are Zdonz a orres==01as aze <br /> provide7 <br /> S. R.--;ease CombLr'ole Gzs/Or/g_ Mer°= <br /> licence of leaks/smil contalim'dor: 140 [ ] Dete=r Lubes (Soe.=r/) <br /> Doc�anred Crot=dwater con�=inadon: C j `:=S C 1 NO [ 1 ?I, coiori"con Detector <br /> 3zctground and dese'pcon of any?re lious _vesdgadon (I Crg-amc Vapor A=iy= <br /> or incidence: ( 1 Other, specify. <br /> [f`anitot2g s '^ems are not _sed <br /> Ztipnale or activir7/area re5t'HeCM1: <br /> 5. Pocezntial ^ez!c znd Saler/ <br /> ?hysical COncs-.s: Cc=e '' ail :bar apply & d scoe) <br /> [ ] -ear or Cold S�ss: °F (higiii ambiens ce✓p.) <br /> [ ] Noise Source: 2 Personal P:oceeve E^uivme-, <br /> [ i Or/gen De=de--gr Level of Prore;=om: C]A [ j2 C IC D <br /> 1 ] 1ca7anon: Cfzs, ..:Ds snppmg, QVC-ins) 14 Hard bat <br /> ( ] -aneling and Transfer of a •rar_rdous Substance: Safety gasses/goggs <br /> CExe, ezpiosiors, etc) Steer toed/shmk shoes or boots <br /> ( 1 Con.2zed Space er (explosions) (j Flme retzrdanr coveralls <br /> f ] -ezvy ecuivme=t (Physic injury& c ata resulting Q :Hearing=tee-on <br /> =om moving equivtae=r) C ] Tyvek <br /> [ ] Respirator, Qc.e: APR or SC3A <br /> [ 1 Ouse_ specify A/D cr-�.dgs: <br /> X Safery ver <br /> 7. A_^tidvaced 3iologici Hazards: C I T,wo-way cotdmuaiatian <br /> C ] Saakes C ] Esecs C ] Rodents C ] Poisonous Plana <br /> [ ) Oche.- C nlmocvn (specy): PAR-IV <br /> PL"14 APPROVAL I <br /> 8. Narrative (Provide zill inor-adon which could mac:Health / <br /> and Safety, e.g., power Ls, inreap-37. of dices, :e_--'in, ace): ?lz= prepared by. ptdvl Date: <br /> Plan lxproved by. <br /> _'?308: (2/77/92) <br />