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0 i <br /> S,.uX 10AQUIN COL?',iTY EN.7/MCMvMN- SAI. PEEAL-M DIVISION <br /> SITE ;-SALT„ -YD SAFE= PL-A.�NN <br /> ?ART a <br /> CENTER-AL SITE IN-FOR MMON EV=AEON OF POTMT Is.AZARDS <br /> N\'� l kM4-- 1. Cae�icaIs "r"ata*os <br /> 1. Site Mame: ��e�. o.J' �N <br /> Address: LOQ? s `JmE"4-E A4-c--- P,-Cardaogens: <br /> Contac:?e_rsoa: !�:,cA� Phone No. -2-77"a37e f I Corrosives: <br /> Sweevs Number: f I Ousts- <br /> Pr000sed Oate of invest ;-ddor/1aspec^oa: 4 ( I E=losives: <br /> j nammables: <br /> ? Desamdon and brier:==&e or aspeyoa ac^viry. f I sorganic Cases: <br /> ( I New USTi t:oa ( j UAR iavesdgar<oa <br /> � Tank Closure in ?!ac_ [I Tank/ume Repair f I Oad�e'S: <br /> 1 1 :ar-V?ive Removal [ I Re--Xcavaz oa f 1 Pa's: <br /> ( I installation or 3ori--V/Mankoring Weds <br /> 3. Sceciirc Site [n-rot•-:adon: REQL�t© P SONAl.P:ROTr.GZNE <br /> 'ankTo. Tank Capadty. al, 1G m EQUIPMEYYT <br /> Tank Contents: C,-gwg5 V,...¢- Lank Psge- <br /> Otmer: 1. Monitoring Squipraent: (note: Mar-itorng <br /> mut be wed or ail operations <br /> ?. Tyne or Coe_-anon: C�� Ll--.less avoroorate:adonaie or:es—a-e-ons are <br /> ?rovided) <br /> �. reE.i <br /> lease story: 1;7tCombusdDle Cas/OxTgea Mete <br /> =ridence or leaks/sail comran *+anon: [ I ?e...5 (4-"RO [ I Der--=or Tubes (Soecf7) <br /> Doc-=e--red Groundwater. canra=inadon: [ I YES K-MO [ j ?hLotoionizz ott De_ecmr <br /> 3ac{;ound and des=-kion of any prvrious invescigyon [I Cr-,=c Vapor 1=aiyzer <br /> Ortel sped_-. <br /> or indde^_ce: f T. T <br /> [f=cnitoryg ''Lents are mot^sea, <br /> r_'orale or acdviry/area res-k-6--ie-ons: <br /> S. ?oce-nt:a1 Health and Safety <br /> Physicai Cance---s: (chers all d=apply& descDe) <br /> ( J =est or Cold Saws: °' (high ambipnr•P'^n.) <br /> �ise Source:_ Z ?e_oral Protec^re .^uiptaenr <br /> C ] O=N'-3 T" - *c'l T--ve? of Prole yon: [IA C IB [ IC NO <br /> P--=�cavadon: (Falls, S:ps ,slipping, cave-ice) hac <br /> C�-F`an dling and Transfer of a Hazardous SSafety m1 azses/gog es <br /> (Ere, explosions, etc) kr Steel coed/shank shoes or boots <br /> ( I Conned Soace end: (explosions) [ I :lame retardant coveralls <br /> -eavy equipment (physical, injury& amn a resulting Proreyaa <br /> Nota tt oviag e?uiptaert) C I T7vek <br /> ( j Respirator, drde: APR or SQA <br /> f I Other, specify A/P ca'-=dge-.- <br /> f I Sarery vest <br /> 7. Anticipated 3l, og,.csl Hazards: C I Two-way com==czmoa <br /> f j Snakes [ [asects Rodents [ I Poisonous Plants <br /> ( j Other/Ua!LnOwn (spec t ): PORT IV <br /> PLAN APPROVAL <br /> S. Narrative (provide all in otsaation which could imoac Heaits <br /> and Satery, e.g., power L fes, integrrr of(0kes, ce_=aia, etc-): Ptah Prepared by. Date: / <br /> P!an A.oproved b Date! <br /> '22.081 (2/7/92) <br />