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I <br /> Ski 10AQULN COLLA i'.t r EV-V URON-kL� : ;. :-=E AL-1z 1 DIV-IS10N <br /> SIT= 1~�; TH A -D SAFETY PL_k N.. i <br /> ?ART i PART II <br /> GENIEU,L Sl:r IN4FORRM`Ai�lON EVALU-CION OF POT N LIAL HAZARDS <br /> _. Site Na^e: �t,7 CGU � uu ��Z � 1. Cie=ic3Is 'r' rds <br /> 41, <br /> CComa=Person: Phone bio. CSweeps N'uraber.. G (r l Dt== <br /> Proposed Date of EXPIosives: <br /> i�rr�m�nles: <br /> 2- Deseiption and brie:nmr-rami7e or h=e^'on ac^viry: [ I inorgat:ic Gases: <br /> ( 1 New UST 1=211arion ( J UAR lnvesrig'ation [j Metals: <br /> [ 1 Tank Cost:-e TL- Place [ J Tank/.P.-pe Reoak [ <br /> ( I Tz`k/Pipe RPp—ovai ( J Re-o-mcavzrion <br /> [ ] l anon or 3orngs/Morzr We?ts <br /> N.7Z fk-f lve - .ARI iii <br /> 3. Soec_^c Site rT* ^_.anc=- RFQLZRD P_4S0KAJ_P:L=ZC=_ <br /> a_^_k No. Tank Capacry EQULp3i'I <br /> Tank Coarents: Tek:A;e: <br /> Cti_- MO^_i'torr'g EauiDmemr: (note: Mo iroririg <br /> �� � _^s=e-mts m�:sz be used or ail ope_,-zors <br /> Type of Ope_�tion ���"- <br /> unless aDDroDr'ate 2Lioaaie or.es�:c_otu are <br /> ?rovide_j <br /> 3. ? ease � torf. ( I Corabun ole Gas/Oxygemm Mere-- <br /> Dride_nce or leaks/soil cor-mr-inarion: [ j NO ( ] Dere=or Tubes (Scecif-/) <br /> Doc=men-red Grourdwar_- corm-inarion [ 1 <br /> NO [ t or�otoio t tion Derecor <br /> 3actg=ouad and desc mon joan��evioR�7esmggazzon xr,11 <br /> r;nic Vapor=z:,yzer <br /> or inccdeace: I � /htNsi;, N 0 Otter, spe�iy. <br /> If iOnitO. g a — '�^..en-= a-re Dor .:se,4 <br /> z=orale or acrivimr/are_ rest_-:c_o=: <br /> 5. Pocen-t ai ea<t- and Sa+e_ry <br /> ?6 cal Conce_^s: (crerf ; ar appiy & desecDe) <br /> "r--ear or Coid J� esS: (high ambie-*temp.) <br /> ( ] Noise Source: 2 Personal P-ote�ve auipmenL <br /> ( 1 O'rN--n Dencencj- Lev o-P_-orect = []A [ I8 [ IC ( ID <br /> ( ] Excavation: (`ai?s, oS rsiiDDin cave-ins) Fa= izaL <br /> .angling and T:ansr - or�F�M�ousorb c Sare_ya.:ses/gog�es <br /> (Ere, erpiosiotsetc) 2y �TN4 Steel. coed/shaak shoes or boots <br /> Congaed Soace erg: (exposons7,axne rerardanr cove_-ails <br /> ( j -eavy e?uipme=t (Pirysicai injury& "a=a resulting ( ] =ezrng protec=on <br /> =otr =owing cuipmert) [ J Tyve-k <br /> [ J Respirator, circle: APR. or SC3A <br /> [ 1 Od er, speaify . c=—"-d.-e: <br /> ery vest <br /> i. Anticipated 3iologic_i Fm rds: Two-way communiczt:on <br /> [ 1 Snakes [ 1 insects [ I Rodents I Poisonous Plants <br /> [ 1 OL^er/Linlmown (specify): ,1J'�.----� PART N <br /> PLAN APPROVAL <br /> 8. Nar-alive (provide all ir-for_.ation which could inpac_l-lealr-b <br /> and Safe_:y, a ;-, Powe- ^es int ,,,rj or dices, .e_ etc-): ?I= Prepared by- ED'ate: <br /> Plan 1.Doroved by: Dar_: <br /> '2308 i �f/92) <br /> I <br />