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Potential Hazards (check boxes that apply to the site): <br /> [] Corroded containers j] Visible leachate [c] Udergrounu tanks <br /> (] Visible soil contamination [] Odors [] Surface tanks <br /> [] Observed free product [] Dust [] Observed tanks <br /> [] Open lagoons [] Open pits <br /> [] Air stack emissions [] On-site surface water contamination <br /> [ ] <br /> Visible on-site releases j I Off-site surface water contamination <br /> [] Visible off-site releases [] Interior budding contamination <br /> [] Visible on-site erasion [tj�No obvious hazards <br /> F. SgE SAF>;I'V W1QRK PLAN <br /> PERSONNEL: <br /> Team Members(list) Res nsib1ity <br /> _ r <br /> 9"1 11AKI I _ _project Manager <br /> Site Safety Officer <br /> la iaMtw F Public Information <br /> t" <br /> a,.d 1W Feld Team Leader <br /> FE.b.BIETER ESTABLI5EMIEI4T: <br /> Map/Sketch attached: Yes [vj No [] Site secured: Yes [] No [ ` <br /> Perimeter identified: Yes j ] No Zone(s) of Contarn2r1ation identified: Yes [] No [LY <br /> INVFSTIGAIION-DERIVEDMATMUA]L DISPOSAL: <br /> r- Disposal of soil cutting and water are the responsibility of the subcantractur. <br /> Fl. PERSQNAL SA <br /> SITE ENTRY PROCEDURES: <br /> PERSONNEL PROTECTION: <br /> Level of Protection: A [] B j ] C j] D [X] <br /> SP-411.11[1RGPags 8 -, <br /> i, <br />