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0 0 <br /> JOAQL7LN COTjW �IVRON ti ? =-=- <br /> =H DIVISION <br /> SIT^ 1EALTrI AND SAMY PLAN <br /> i PART II <br /> SAL 517E INFORMAi[ON rVALUAnON OF POT=N—L-L L F--A71RDS <br /> i. Site Name- Eft vPaClie=icals 'r_a ds <br /> Address: j:'I E. YV(wwAA-W-' [v>'Caresogens ']n�n�2� 1� <br /> Conmc Person: phone INC.- [I Losives: <br /> Swee?s Number ��5 ([/1 Dtts s: C, <br /> Proposed Date of yvesd;acan/insueco=: Ub C I 1 <br /> [ =pies: t (.viCJ <br /> 2. Desdpdon and 'brief—=rive of fnsDeccmioa ae=vity: [ 1/�norogpnic Gad <br /> ( 1 New UST Macon [ I UAR.Investigation C✓1 � = �� <br /> [ j Tank C:orn-e in Place C I Tank/Pipe Repair [I oaeize 5: <br /> Tzr_k/Pipe R^�ooe! C 7 Re-=cmmmon C7 PC3's <br /> [ ] Insmllarion of 3or&-gs/Monitoring well <br /> PART S <br /> 3. Soe,^"c Site L--'orsario=• _ _ R-QTJ= PE4SONe+1.PRO'IEc 1VE <br /> Tank No. �d Ta x GDadty 5 d O f7 G EQULP'N=1 <br /> Tank Conte..^rs: /Yl V f u e �� T 'y" < ^1 <br /> Moairog -gmDment: (norec ?dOmCOrin0 <br /> r^ <br /> r Lre/J [�( <br /> i=s=-=en; mus-, be Used :or aL ope_2no= <br /> ype Of C De aL pn Fy�[ VULJl+� U S! �C 12c a L�J C less aDDrocr ace Zdorm a orres�cC'ons a- <br /> provinee) <br /> 5. R.—;ease Fsror/: Ct}<ombusnole Gas/Or/ge-- Merer <br /> =ridence of le=Ys/soil corm1ni=zri0n: [ i 'j ( I NO C I De:ecor Tubes (Specify) <br /> Doe_m ^red Groundwat_ comraminadon: ( 1 `r=S C 1 `40 ( I Photoioni=-rion Derecor <br /> Or�sic Vapor A=2- <br /> 3adtground and descDcon of airy previous :nvestigacan (I Y <br /> or inddence.• iQ/Yl:r 1n J [ 1 Omer, specify- <br /> - <br /> pecify <br /> —�naA `,oL, a . If motitorg ��—enrs are nor _sed <br /> �. <br /> radonale or ac*viry/area reser c=ors: <br /> 5. Pore^_dal Heal&- and Sa:ery <br /> ?� Conc_�: (caeca all iar aDDiy & descoe) <br /> (v} e� or Cold Stress: i Ulf °: (riga amnia=t res-D•) Personal p:•ote� .. <br /> ve zuipmers <br /> ( j Noise Source: J0 a G tK{LaX- Z _S <br /> [ 1 gx)gen De=cencr Le of P ote_an CIA CIE 11C D <br /> ( _ cavadorc (lois, crsDs SiinDing, cave-ins) [ oat <br /> ( ] . Safe_ a ses/go 01 es <br /> zaaling and Transfer of a c?ar_rdous Subsmnce: ' '� 'y � <br /> (Ee, miosiors, etc) Vste_� coed/shank woes or boots <br /> [ e <br /> ] armed Soar_ n=: (emiosions) C 1 ^ame re=d= cave-a1s <br /> [_C-,=_avy eamllmenr (paysicd jury g[ ¢aL a resulting (y] erzg protecon <br /> from moving equipaerr) '2.4 k ,60_4 C I Tyvek <br /> [ ] Resoiraror, ode: ?FR or SC3A <br /> ( 1 Other, specify A/P c. :dge <br /> C,-rtafery vesr <br /> 7. Andcipared Biologi=l Fz=ds: C I Two-way com-unicdon <br /> [ I Snakes C I L^sects [ I Rodents C I Poisonous Plants <br /> C I Of^er/Urilc:own (specly): DART IV <br /> PLAN APPROVAL <br /> S. Nax:mdve (provide a-1 tormarion which could impact Health (l. ' 7-,3(-1)0 <br /> and Safer, g., _power 1=es�, in�r�e— or rncees, reg mn, a=e): Ptah Pre?aced SyL P1( Dare: <br /> Lr,i a ' a: Is Awl <br /> ?tan Approved by. Dare- <br /> =s308i (2/7/92) <br />