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<ZAN JOAQUDT COT= E.VVMO?4NE:VT.AL, E F3L.TII DIVISION <br /> SITE FF--kI.TH AND SA)-�.TY PLAN <br /> ?ART I PART U <br /> Gr1�TER.AL SIT INFORMA=ON EVALUATION OF POTENUAL FTAZARDS <br /> Ls <br /> I. Sire dame: � f�flq-/ plz.lm I_ Qemicals hazards <br /> Address: cA I �2, I r ah n sa-- I-Z'sp Ljcaresogens: e2iYy10sn14� <br /> Contact Person: ^,phone No. C I Corrosives: <br /> Sweeps Number t I I=lo t jC CC✓I jf G�yc- <br /> Proposed Dare or avrsdgatioa/insoecaon: � -f ';�lasives: <br /> N clammables: M u D Il . <br /> 2 _Descpaoa ;{d brei ave or m=ec=on ac_viry: [ ]'Tnorganic Cases: <br /> New a [ I UAR Iavescpzoa Memis: jJp <br /> [ ] Tank �?lace C ] Tank/Pipe Regan ( 1Oxidizers- <br /> { .inti Re-g-oval [ ] Ie-. cavazon [l PC S: <br /> [ I rnsrallaaon of Borings/Monnaring Wells <br /> ?4RT 01 <br /> 3. Soecec Sire E-For_aeon_ 0©8 ©0 REQLTRED Pr—QMNA.L PROTC= <br /> -ink Vo. cZ r'{ ankCapacry 3- Iolr EQUIPMEN-J <br /> am Contents }anic. <br /> Othe . 1. Monitoring °auipmene (note: Mon;coeng <br /> L / nsc_ment must be used 'or ail apocadons <br /> 1. Type of Cne-aeon Ci Qom/ 7 27 , &yt, unless au <br /> aroorace tacoame or_es=-:ccons are <br /> arovided) <br /> i. 3eiease Fisrory: [Cambuccle Gres/Oxnes Meter <br /> nder_ce or leaks/sail coag^ n��oa: =i [j NO ( I Desecor Tubes (Speer-7) <br /> Doc_menred Groundwater contamination `15 ( j NO [ I Phoccioni�con De•_e=r <br /> Background and descpcon o[ate{previous mvesagacon [I Organic Vapor?raiyzer <br /> or incidence: �" /"�' Y i C I Ocher sgeciy: <br /> If monimerig ¢s"ments are nae sed <br /> rationale or acrivirf/area rescccons: <br /> 5. Pare^_cal " ealrh and Safety <br /> Physical Conc_.s: (check all „-'sat apply& deseoe) <br /> hear or Cold Stress: >I. .6 °i (!nigh ambieVr;.e=p_) <br /> N -, K oise Source. b0.c —k. ,c 2 Personal Procecnve e?uipmennr <br /> C 1 Oxygen Deficiency Level of Proce=os C IA C IB C IC ` !D <br /> Q =.,-,von: ¢p siipoin; cave ns) <:ard hat <br /> C ] handling as .ra=e-- of a iaz=dous Subszznca: Sai •y glasses/gog,es <br /> (fire, emiosions, ere) xsceei coed/shank shoes or boots <br /> Confined Space enar. (expiosions)-'rAn)=11 iM. ( 1 ---=e reratdaac cave_ralls <br /> [ Heavy e='DM ^s (physical sjuxy& -•a= rewiring �:earing prom--^on <br /> rota moving equipmerc) C 177we <br /> ( j Resairaror, ace: APR or SCSA <br /> C I Other, specry A/P car=dge: <br /> ' e ) D W Safervesc <br /> i. Anacipaced 3iologic:d c^aza_n+'<: ✓ C I Two-way commnnic=mon <br /> C I Snakes C I rmecs C I Rodent [ I Poisonous Plana <br /> ,'(>&ther/ummown (specify): PART IV <br /> PLAN APP20VAL y <br /> S. Narrative (provide a1 informacon which could �znoac Heakh <br /> and Safer/, fig., Power lines, integrity or dikes, :e_-Bin, ere): Plan Prepared by: Dace,Ada A . 0 / <br /> (I lt,r,v4 fill <br /> ?tan Approved by-._ ate: <br /> ="2°081 (2/7/92) <br />