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SM ah-I i A.ti'D X4 <br /> Pra azed By <br /> I. OL-Aral Inforaation UR 3 0 1991 . <br /> A. _=ie;t 'da�tificttioD <br /> X8111_ rH6�r7� �.ert/ <br /> 1. Division 2. Ce —Tf- <br /> 4. Site Sam t.&.s24G 5. client —6m&&-/q —mac• <br /> 6. work Location Address d-5�� Il',t <br /> (St-reat A .tress) (city) (State) (tic) <br /> B. Lte Histo:y <br /> 1. Das=ibe briefly 3 s�- eZ,,i -"Xc.'AA'.i,7. 6 p,e« TC,onL• stad1'^!s <br /> C. ��not o! Werk <br /> 1. Ges ibe briefly ro -74A rE 7t r r2 �y�—.tp•• s o.r,.c�_�_�nm <br /> �gF c-.a '3 - <br /> L ) Sit* visit only. Sita HMT_net ftocMUM, lift pgrso=ll h&M c Sian-of� belw <br /> D. r�,�..j Ass�..•+e�t�� P�'idSor`G ;a- ,. <br /> 1. Frdicate Yes (Y)/No (N) to typee of hau-ds anticipated. W ) physio'Laical; <br /> Taz:c CA—. a <br /> Al - Levels i✓) >r-%'-777+, 3-MM; (..y' B440--Hazards,' <br /> 7rysiesl; iV) cr-,."tmction type; (M In3:s`-riz'_ typo: <br /> Ird•,Lst..y tYPa <br /> 2. Sits Ran::a`.ory Status; CMT-A/S - (ya U.S. EPA, (•✓) state, (,-A fir:. Site; <br /> SAA - (tij U.S. EFA, (v ) State: = - (v ) 1910, 4/ ) 1926, State; <br /> IM - (ti") 10 CFR 2J; Other Fed. Agarr y - (.v) DOE, (,t,4 Aix FcrcC2; <br /> Baso..'' cn the Hazard hssesse.••,t and peglatory Stats, deteardm t`,e swdlu-d HASP(s) <br /> a�liabla to this project. Irdicata below u41ch Stardard Hasp will be used a;x( <br /> appvd tie apprvpri.ate paw of this porn alcnq with the Sta-da.si Plan. <br /> 7. Starriaid Plan to be used; (01 Sick Test (ti) Air EtissimF (v ?s�astos <br /> (.t.} indxtrial Hygiene (� Ufa Systcs (Y) FAZa.-daus VAt. (-✓} ons*^action <br /> a+') ,,4/DOE (.v) usAlltrt9, (M Air Force <br /> D. <br /> or' <br /> 1. fie�ie-ed by: a. P.K. tBt.0 <br /> b. P.D. Lata <br /> d. SHSC Cate <br /> 2. A�*r^JJ23 FY: pate. <br /> ( ) a. CCCperate riea'th and Safety C:rOctor (ClSDj <br /> ( ) b. D6:/F.,O` io Lwi*r ifi deleaiLiQn 4 <br /> P �jee Start Date z ;rrd Date :gAZAVI. Thio sitf be <br /> iaru•_</A rov for anaa <br /> y activities Ot4tad apart Data <br /> Dates) 1. 2. 1. 4. 5. <br /> l38' <br />