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SA.'`I IOAQLE"t COLNi`I' E-N-IRONMENTAL. P kL,T_I DIVISION <br /> SITE I AL.T H A�-D SAL== PT-ANYi AL <br /> P ART X PARR a <br /> GENEM. SM INFORMAMON EVALUATION OF POT 4T AL F-AZARDS <br /> / * 7A4is 1 C:ii4-AqI <br /> 1. SireName: ` _ I. ca r-iia2azds <br /> Address: Carcinogens- 7 <br /> Contac:Person: Phone No. fc 4'.e9 Qui [j Catrozives: . <br /> Sweevs -Number: [ I Dusts: <br /> P-oposed Date or investigarion/inspec,ion: [ j slues: <br /> ( ammables- <br /> 2. Descipdon and brief a =d7e of inspe don ac=vny. [ I Inorganic Gases: <br /> ( 1 New UST i*+ i adon [ I UAR InveS-I_i at on [I Memis: <br /> C I Wank Cos n:A Place [] Tank/0ipe Repair [ j Oadizers: <br /> ipe Remo ( j Re-=Cavation [I PC3's- <br /> ( I installation of Borings/Monitoring Wells <br /> PART DI <br /> 3. Scecidc Site Im*otmadon: REQfj= PE4SCNAL PRO'13CTISIE <br /> i'arik No. tank Capacity: 1S-. c ac- EQUB'MD.r <br /> Tarek Contents: y P!a Tank Age: <br /> JF- <br /> Cther: I. Monitoring Equipment: (none: Manitorrig <br /> s.::S.enrs =. st oe used for all ooeradons <br /> ?. Type of Operation: AAZ 1 :�-a,� '� -�1 J� ,� —Hess appropriate:adonale ones` tons are <br /> ?rove <br /> S. release �.iscorf: ' `[ ComauszDle C:as/Osygers 17/teter <br /> Evidence of leaks/soil contamination: ( j -Je...S 40 [ I De_ec:or Tubes (Soec^-: <br /> Docamerted Groundwater conramiradon: ( IMS [O C I PRotoianizadon Decec,or <br /> 3ack-bund and des=..ion of any previous tyvestifiton (j Organic Vapor Aaaiyz`r <br /> or incidence: [ I Other; specIT. <br /> V,y anitoring iZs==ents are :roc::sed, <br /> radonaie or actfviry/area res---; s: <br /> 5. Poce_^_tial Health and Safer,/- <br /> Physical <br /> aie^lPhysical Car_c_^.s: (c ec!c ail diar apply& descDe) <br /> ( j H.eat or Coid Sys: °�= Cpigh ambient m—_D.) <br /> C I Noise Source: 2. Personai Procec ve Equipmenr <br /> (_I O en Deficiency: Leave- or Proce don: C]A C IB C IC <br /> "CaVAd0a: CEWS, T:pS Slipping, Cave-!IIS) K.Hard Rat <br /> [ Handling and Transfer of a c-:azardous Sabsraace.- CTgiety Biasses/goggles <br /> (fire, espiosions, etc.) [ eel coed/shank shoes or boors <br /> ( j ed Soace entry: (espiosions) [ I Fame retardant coveralls <br /> ( Heavy equipment (Paysicai injury& aauma resulting C j rearing protection <br /> from zovit:g equipment) <br /> 11 Tpvek <br /> C I Respirator, cirde: APR or SC3A <br /> C I OtRer, spec±ry A/P ca-^dp.- <br /> ( I Saier_y vest <br /> 7. knticipared Bio gic:d i4-M_= [ I Two-way ccr�enicariot! <br /> [ I Snakes V IInsecw Rodents C I Poisonous Plants <br /> C I Other/Unk-sown (speciry): PART N <br /> PLAN APPROVAL <br /> 3. Narrative (provide a?ll information waic s could i=ac,HealtsA <br /> rt e.c r or ar 1- Nan 7r� ri e <br /> and Saie_y, ,, Powe:IiLes, iare,__ry of d:Kes, :Brain, C.,- a. :.�paze_ by-. +3are: <br /> Plan znproved by.L Dare: <br /> -23081 (2/7/92) <br />