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k <br /> h <br /> V <br /> SA1 JOAQUZN COUNTY EW1RONR , AL I=.•.LT - Dr47SiON <br /> SITE N-EALT E Al S PLAN <br /> ART I PART B <br /> GENERAL. Srr.-m INFORMATION EVALUAILION OF POTENTIAL F:A ARDS <br /> i. Sire Name: � ' � ka✓ ��� 3.. Chemicals FX-7 rd$ <br /> redress: Zlc'arc�mlogers: <br /> Contac: Pe_•son:aO( Lock U- Phone No. [] Corrosives: ; <br /> Sweeps N=ben .[TDuss: I <br /> proposed Dare of invesrigation/i.nspecrio= VtF. 12 S r (o [ ] E_-plosives: <br /> 2tamm ables: <br /> 2 Des=- tion and brie:narrative of fi=ecdon ac^vicY- E ] Inorganic Cases: <br /> ( I New UST Lmsallation [ ] UAR Investigation E ] Metals: <br /> E ] Tank Closure in Place [ ] Tar k/Pive Repair E I Clridize_ss: <br /> j,ar- Pipe Removal ( ] Re--xcavation E l Pa's: <br /> [ ] LMSM[lation of Borings/Monitoring Wells <br /> ?PRT Tg <br /> 3. Soe-c Sire Iafor—ad= REQL= PESONAL PROTECTIVE <br /> Task No. t _Z Tonic Capacity: l, EQULPkiENI <br /> Tars:K Come^: Tank Age: 4,I'L <br /> Crrse_r 1. lrloairor=g Equipment: (none: Monirorng <br /> :mJ <br /> �ws� e:rs mur be used or a operadans <br /> Type Of Ope-ation ����s S ,iU�� unless apvroprzre =^ationaie orres=:c^ors are <br /> provided) <br /> 3. Res ease F:srory <br /> Combcseole Gzs/Cayop� Me�e_- <br /> �ride^.ce of leYks/soil conraminarion: [ ] YES {TNO E l Dere nor Tubes (Specify) <br /> Doc,-=enred Crounaware- con minarion_ [ ] YES {-11,10 E ] Phormonizscon Derec:or <br /> 3aci;round and des=- tion of any previous invesdgarion [] Organic Vapor AyaiyzL _ <br /> or incidence: { ] Other sperm**/: <br /> If moniroring 'r e--s are =nor used, <br /> radonaie or aCr Tir//ar■ea resn':c_ors: <br /> 6. ?orem-r_al :Health and Safe^/ <br /> Physical Conce-ms: (check all that anoiy & desc:R)e) <br /> [ ] Hear or Cold St:,=: OF (high ambienr re=p.) <br /> C Noise Source.- 2 P_*soma? Prora-ve Equipsenr An <br /> [ Oxygen De cease/ Level of-.-ore�om: [ ]A [ ]B E ]C <br /> Ik�el E_-cavaz<on: (falls, nips ,slipping, cave-ins) _ , ] ;^:and hat <br /> Handling and Transfer of a i-:azardous Sabsance: Sa&-7 giass <br /> (L—e, explosions, em.) <br /> [ Ste°_= roed/srank shoes or boas <br /> E l Conf ed Space easy (explosions) ] Rmne rerar�r coveralls <br /> (r:eavy eauipmemz (pirysical Injury& ua=a resuiang ] ::es g Protecrinn <br /> t rolm moving equipment) ryvek <br /> ( ] iraror, ckrd-e: APR or SCBA <br /> [ ] Or+�e-, specifyA/P cis u:d,p: <br /> [ Safety vesr <br /> i. ant cipared Biologir_l Flazarrds: E`] Two-way cow.:.•.nicar*on <br /> [ } Srszkes { ] Inseams { ] Rodents [ I Poisonous Plants <br /> [ ] O cher/Ur?imown (sp eery): PART N <br /> PLAN APPROVAL z9 1 <br /> 8. Narrative (provide ail iniormadon which could impact Health <br /> .� b <br /> Dare�v (� <br /> and Safery, e.g., power lines, inreg z'/of d:xes, re---a=, !rc-;: Plan Prepare_ . <br /> ole:Lpproved by- Dare:o <br /> ?3083. (2/7/92) <br />