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6 <br /> S.aiY JOAQUIlY COL1Vi'f �T�20NltiS1r`+T.�I. I-��I.T:ri DI'v�.SiON <br /> S=r- c-M4L,TH AYD S TY PLaN <br /> ?ART I 1)ART II <br /> C"VERAL SITE e4T40RMA=ON EVAIUIIP.'IION OF POT- MAL FAZIRDS <br /> 1. Site .Name: :141A [o. 1. Che=icaU Hazards <br /> Address: -r_U q pi eE7/w4 0 CI Carcaogens <br /> Conmc_ Person: � ?hone No r-k•/ �8-6r�g [j Corrosives: <br /> Sweeps Mumberr. zv'S3C�7 [ 1 Dusm <br /> ..Oposed Dare of iavestigadon/iaspecon: E losives: <br /> ?azar a^les: <br /> 2. Descipdon and brief nanadve of immecon acuity: [ r[aorg-dnic Cases: <br /> [ 1 New UST t„=anaron C 1 UAR!aves",-sadaa [j Memis: <br /> C I Tank Closure a ?!act [ j Tank/Pte Repair ( j Omdizes: <br /> C�ank mipe Removal ( ] 3e � varan C l Pa'r <br /> tallanon or Bodngs/Moaimring Wells <br /> ?ART t'II <br /> 3. Soec:Ec Site ��ror=C s P`—"RS011r'I ?R=GZIVE <br /> Tack Vo. 15;7 &,� dorars Capacitq tam l3 EQUPME`IT <br /> Tank Contents: 645 / G TankAge: / 7 e <br /> Monimml- Sauipne= Chore: Moricorin; <br /> rsu­sena muse be sed _or all opezadans <br /> ?. Type of Coeradon: 5hq 9-,"WRA _.less womaeace radomle or-es=cans are <br /> provided) <br /> 5. Release F isrorj: � ombuse"ple Gas/Oxygen Merer <br /> cuidence of leaks/soil co ramni*ation: C 17S C I NO C j Dewar Tubes (Soeri7) <br /> Doci=ented Croundwacer contamination CIMS [ I NO ( I Phoroioniadon Deur <br /> 3ackground and dese ptian of any?revious _^vesdgadoa [j Crganic Vapor Amai7cer <br /> or incidence: C I Other rPecTr_ <br /> !f mnuiror g are accused, <br /> ationale or acdvirj/ars; reser cans: <br /> 5. Potential Health and Safety <br /> ?hysicsi Conc_^_s: (c=eck all mar apply& des=be) <br /> [ ] Feat or Cold Stress: o� 34bieur <br /> ceoise Source: Gr�'A 2. P•soaai ?rOcecve E==e= <br /> ( ] Cx7gen Degcienej Level of vmce=an: C ]A [ la E x I- <br /> z. cavatios Calls, cm.ps supping; cave-ms) &crg rrc,c) (�°'^sd '¢at <br /> [ I Handling and Trans&-of a F-:azardous Subscance. [Paie_r7 asses/gog.es <br /> (fire, explosions, ere) [ Steel coed/shank shoes or boas <br /> [ ] Congaed Soace entry, (explosions) ( 1 =!arae ze tr-3a„r coveralls <br /> IN Heavy eauipmenc (physicaL h#=7& craurna ti 'rearing?ram=on <br /> ¢om SOvIng ecuipmenc) ZdeAG r L,,, CT T7vek <br /> 9C • ararc <br /> 4espir , de o SC3A <br /> [ 1 Other, speciy At? <br /> ( j Sarety vest <br /> 7. Anticipated 3ioiogic_l •razards: [ I Two-way cararrmxiction <br /> [ I Snakes C I insects ( ] 3odenrs [ I Poisonous Plana <br /> C I Other/UnknOwn CSpeVZY): PART N <br /> PLAN APPROVAL / <br /> 8. Yarnrive (provide all infor,..adon which could atpac Health <br /> Plan ?r_Pared Sy. <br /> and Sart_ e.g., Bower Innes, ares rf Or COKES, M=Aia, dtc.): Date <br /> f <br /> ?!aa Aoproved br. _ Da-c-4W <br /> L2.3,08i (2/7/92) <br />