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Sl� Nr i C.A QL7L r COUP i !-v�Zo���+ _fit =- AL H Drv=SioN <br />�"' I <br />CyNELaL = 244FORi1 AIMN <br />L Site \T=. a: <br />-Iddress- '1 4-'- Ij <br />Conzac= ?e_-soa: C h o�oae No. <br />Sweeos :Vu=be-: ,� 3 1 Oct 7 <br />P-000sed Dare of west=g=orlT_=uecon: <br />Des=udon and 'brie= of ==, a _on acuity: <br />[ 1 L\Tvv USS L 'on C I UAR =esd;anon <br />C I -a.ns Cos—.re in ?qac_ [ I ; aLit/P pe Rev=' <br />X: ar=ic/pioe Re^Tovai C I :fie-=CaTjtoa <br />( I E-n-vadarion of 3ar..._gs/Moniror-�ng 'Ne is <br />3. SCe'-4i;c Site (=*OL_^3cOn: 2 _ / ;� OGS - /O GCVO <br />71n'{ Conre Ls: ✓(,1peri 11r= C- �e,.�,.n� Via. <br />I. i yoe of Coe.-=dan: <br />5. Rei=ase H=sror)r <br />3'ride_ce of ?e-,=/soucoac*^�^=roa: `,p�"'v� C I tiO <br />DOCT--red Grollndware-- _Oar's rar on: (I ?t j C I VO <br />3actrvund and des=ton of any ?reviaus i=7esd,adoa <br />a. POC—mal ' e_' tll and Sa C7 <br />PtysiC_.i Canc_---s: (cYecc a2 .;.ar aaoiy & desca.e) <br />X.ear or Caid Suess: °� C=gn =Die✓r v✓n.) <br />Noise Sou --ca- ba <br />DeCd=CT <br />a <br />c3vadon: (.atIs, s sijppm' cave-ins) <br />Handling and Transfer of a i-=szardous Sucs=c_: <br />explosions, e=) <br />C I Coadned Soac_ e== -j; (e=piosions) <br />-envy equipates (pay==' =jurj 3c esuidag <br />7. cb#aced 3ioiogici Hat: rC.s: /l/ %g <br />C I Sna:Kes [ I [nsecc= [ I Rodes C I ?oisonous ?tans <br />[ I Ct^e=tin clown (spe�ry): <br />3. :Var--=e (provide aE? %ror_:_at;oa waic7 maid i=ac <br />and Sate' -'l, e.-, :OWe_- � s, =0::eg=7 of -C;- ,p_`��i_� <br />?.ART II <br />E'JA1=, ON OF POTS F-AZARDS <br />L C ecic3is Haz--rds <br />�Csr�ogn.^s- UL�it2��'LL�1 <br />C I cz-=M Ives: <br />C I <br />[ Iriasives: <br />YvY^,�r+r,ahies:3 L. <br />C I [.nor anic Cases: <br />��Iects: �G Cc - <br />C I O=idiz_-s: <br />?AR= al <br />.-QTJM= PW—RSCNAL ??�OT:.'C SIVE <br />QUPMEN <br />=ed Sar ?.S.j opermtoIIs <br />u=iess a=roorace =doaaia or7ese_ons are <br />orovided) <br />'kCa=.b= :Dle Gas/CX79a M- ec_- <br />[ 1 Cece-ter Tubes (Soe!:�:7) <br />[ I ?Fatoian;�don Deer <br />I CL�''-:c Vapor : =d7ze <br />C i Com; Toe,---;f7- <br />=e=m ara =oc _Se^_, <br />rconaie or ac=7�r7 /are-- res=:c=ors: <br />L Pe";anai ?-vCe--7e E_-UZ=P-- <br />I.;vei of P-oce^_ot;: C IA C IB C IC X1D <br />�:2rd aaL <br />�" Safe_r� arses/;vg�es <br />�Sceei .oed/s.=--k idoes or 000cs <br />F=e re'a=* cave_*aLs <br />�; :e=rg pzot�.raa <br />C i Tyvek <br />C I Iespiraror, -c.:-e: A -P154 or SvA <br />.A/D <br />'KSafe*y vest <br />C I T'Nx)-WZY cat.�t=^.icdoe <br />?ART V <br />Pi -AN APPROVAL <br />7f�� 7re.�aTe� ':y-, Dare: <br />Prar Approved by- 4A ^ i Dace: /. <br />