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r i <br /> S.aY JOAQULN CO=y. EVVrROIIYLN'I AL, r E-kL7"- DIVISION <br /> SIT= r E AL.TH AND SAFE= PLAN <br /> i <br /> PART 11 <br /> G=V -Da L SAE INFORMAilONtt EYALIIP.'IION OF POT-E-N IAL HAZARDS <br /> Site .Name: �^/�n bNJ l Q / _ 1. Che-_icals razz'ds <br /> 416 (j Carcinogens: <br /> Address: <br /> Contac Pn: - Phone No. [I C:3r:=Ves- <br /> Sweeps Number_ [ l Dusts- ✓ <br /> Pr000sed Dare of!nvesc;aLio _elQn°�= <br /> (] :Iammables: 1' <br /> 2. Deseipcon and 'brief nv- rive of insoecon ac=vitt'. [ ] Inorganic Cases. <br /> ( 1 New US rmuillarion [j UAR lavergatiaa [ I Mem: 1/ <br /> [ ] Tank Closu-e i. Place [ I Tak/P Pe Repair [l Oxidizers: <br /> V1 Tan_k/Pipe R•.moval ( l Re •mac tion [7 PC3's. <br /> [ ] r stZEanon or 3or gs/Moniroring Wells <br /> ?PRT)z <br /> 3. Sperm"c Site [='or—arion / R`QTJ= PMLSON+L PROT'CIIVE <br /> ELK No.TA 51 5'?q Tan.'t Capaciry: -I D� y EQUIP <br /> 'ank Contents: oMPN Ia= Age. UNlvtu <br /> 1. Mpa ^ltpLTg �?tnDIIC^.0 (note: YIo +L�LbrIIg <br /> CLle= <br /> ��.e^•TS IIL`sr be used <br /> EDL 211 operations <br /> Type of Cpe�rion Grl2VN Qt( Fat IFGA(1NG� Mess apztionaproprate a or esu cora are <br /> provided) <br /> S. �%zse Ecstasy: <br /> [vj Combus ole Czs/Oxygen Mere_r <br /> _ridence of lo2acs/soil cormriina^on' [ I "-s [VT NO [ I De'-ear Tubes (Specify) <br /> Dogeenred Groundwater coa*�miaarion [ 1 ` °j [�] NO [ <br /> ] phoroio + rion Derecor <br /> 3ack,mmund and dese peon of any previous '=vesrigatibn [I <br /> Or;sic Vapor Aaiyzer <br /> [ t Otter, spe:.:iy: <br /> or incidence: <br /> If monitoring t^r:mem are nor used <br /> ationale or activity/are=_ resec=ors: <br /> 5. Pocenrial 'Health- and Safer/ <br /> physical Cunt.—.s: Cc=e-,, all Czar apply & describe) <br /> [ ] -ear or Cold Stress: of Caigh asibienr re=p•) <br /> Noise Source: <br /> 2. Personal ?roiecve :..^moment <br /> [ ] Level of prore on: [ ]A [ IB [ IC [ 1D <br /> ( 1 Orygen Deride=cy: <br /> [ ] -<ravaaon: (-`al?s, �Ps ,supping, cave-ms) [yzrd hat <br /> [.] rana'Ling and Transfer of a ra=dous Subsance: (-r Safety glasses/gogg s <br /> [%4 Sree_t Loed/shark shoes or boots <br /> IF---, eSJlpslbrS, em) <br /> [ ] Confined Space enn� (exPiosipns) ( ] dame re�danr coveralls <br /> J'r e=r n _rzntectioa <br /> [.j ..eaw equipment el! n & auma resulting ( ] Tyvek g <br /> h7om moving equipment' <br /> ( ] Res-viraror, Qde: ?PR or SC3A <br /> [ 1 Other, specify <br /> .AAP c.�:dge. <br /> [ ] Safety vest <br /> i. Anticipated 3ioiogicm rz Zrds: ( ] T`r'ay communication <br /> [ ] Snakes ( I insects [ ] Rodents [ I Poisonous Plants PART N <br /> [ ] Other/Un1 mown (speciy): PLAN APPROVAL <br /> 8�Na* adve CProvide ail n ormacon which could mac Ideal y. m iJ010 L �r <br /> and Safety, e.g_, power -^s, fare;2t'of b_Kes, raw--sla. etc_): Plan Prepared S .ace. <br /> plan loproved by: Date: <br /> H•2°081 (2/7/92) <br />