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SITE HEALTH AND SAFETY PLAN (HASP) <br /> repared by r ,s} Date $ /1 l q <br /> S6 G/n�T n—f�1 �'� WO Number <br /> O6. 3 -0o.t?-nnj :1 , <br /> Project identification Site History' (describe briefly) <br /> Division v S T�; 1"-196 . <br /> Department/Office �' <br /> ! Site Name 5 :GM L GQvC -- (rC1GL/� �'�t�a 'V•s't"�h yClrO�rbe,f?S <br /> Client STC lVZ Q/� y"�� �-r57;C'-*57 /a <br /> Work Location Address1 <br /> �),o O A), B&c k��� � Pe-rr�!c-2 vim, �y bra cox✓ L�-�.rs no� <br /> 1-0r-4 t GA � c GT��/n c�r�,.�nCl�c1✓cer7��r <br /> Scope of Work (descrtbe briefly) <br /> t� Y1 C, #-r-� t r-c� L) rrG�.,c��+G t- �'1a�z. -ror Ole - <br /> ❑Site visa only site HASP not necessary list personnel here and sign off below <br /> E <br /> qlvEf i <br /> egulatory Status <br /> Site regulatory status Based an the Hazi" Assessment and "uiway status ctote"=the stcneam KA-sP(l <br /> apGrcabie 10 tills protect [ndreate beiaw whicri Slandard HASP*.4 be usod and append the <br /> tpproale pages of this form amongm <br /> w1h the Standd Pimm <br /> C>=RCLA/SARA RCRA Other Federal Agency pn <br /> ❑US EPA ❑US EPA ❑DOE <br /> ❑State ❑State ❑USATHAMA ❑Stacie Test ❑ <br /> ❑ <br /> NPL Site ❑Air Force ❑Air Emissions ❑ <br /> OSHA NRC ❑Asbestos ❑ <br /> 1:11910 ❑ 10 CFR 20 ❑Industrial Hygiene ❑ <br /> 1-11926 ❑ ❑ <br /> 13 State sd`n <br /> Review and Approval Documentation <br /> Reviewed <br /> by <br /> a P M K �f}G.nQ 2 Date <br /> b PD Date <br /> c DSOIRSO Date <br /> d SHSC Date <br /> Aaproved by pate g'f c3[t� <br /> �r-o7i- /1/1an e OFFycr,� <br /> bk <br /> i ❑ <br /> Pre -re? <br /> P olect start date $1j2��� This site HASP must be Amendment date(s) By- <br /> date t reissued/reapproved for any 1 <br /> activities conducted after Da e 2 <br /> 12j3t�`� � s <br /> a <br /> 5 + <br />