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SAN- JOAQLZN COL?V iYt-V�O�t?tiL�:: i. .ALT—H DIVISION <br /> SIT: ria I TH Ati-D SALTY PL-.k-N, - <br /> PART <br /> La NPR:' i PRT II <br /> CNMAL S1:.m 24TORMAnON TVALMAMON OF PO'I^N-11AL FAZ.ARDS <br /> _. Sire Nave: 1. Ch rats i-=az-ds <br /> Address: Zb ':y:x 'wg✓4 re [. --inogeys: <br /> Contac Pe--soPhone No. (j Corrosives: <br /> Sweeps Nufnber-. [ 1 Dusts: <br /> ?-oposed Dare ofvesdadoa/inspect.on: ( ] - plosives: <br /> ? Desc ipdoa and brie:,tz—adve of fi=e^'ors achvirp_ ( I inorg-anic Gases: <br /> [ 1 New UST T^ t at:oa [ J UAR invest:gaiion [J Metals.- <br /> Tank C:osrr-e i:: Place [ I Tar-k/10--pe Rmair ( j Oa ae-s: <br /> [ I Tank/Pipe Rteemoval ( 1 :Le--= <br /> [J PCB's: <br /> ( J am of 3orrgs/Moairoring Wells <br /> 9 <br /> PARI tT: <br /> 3. Soec.^c Site ��ro^_.at;o::.• .RE.QTj= P=ZSOMA.L PR, =.= TIVE <br /> :'a.lk No. Ta--:k Capaety: FQLTioTi <br /> a n k Con ears: T ZZk A,-e: <br /> Ct:le= :. Moniror, =auiprne=r: (nore: Momiror:nc <br /> cur be used or all oper-a-=ors <br /> Type of Ope_mt:o- ass ap or-.are zrionale or ,.c=ons are <br /> ?rovide�� <br /> S. Re-ease E�mrf. ( I Combustible Cu/O=j-.-- Llere-- <br /> Vridence of leaks/soil cnra**+inarior.: ( ] "_'=5 ( J NO ( J Derecor Tabes (Saul) <br /> Doc memared Crourdware.- comm-fradon: ( j `:=S [ I NO ( 1 ?horoioT'i"don Defecor <br /> Back,ound and desc-'pt:on of any previous cvesdgadon (J Cr-g-amc VaporA aiyze-- <br /> or incidence: [ 1 Otte_; specify- <br /> If <br /> perm fyif =onrroayg i:==e=zre= are not used, <br /> mr*or_aie or acctvirt/area res`:c_ors: <br /> 5. Po cental ea!r and Safe_ry <br /> ?!zysic--I Coac_^�: Cc:--e---- ail ::ar apply 3c descDe; <br /> ( 1 ; .r or Coid Stress: OF (nigh arbie-*tarp.) <br /> (' : Oise Sot=e: 2 Personal P-ore-ve ...^uipmerr <br /> ( i Os�lgen Denceacjr 1--v x" of Prore^ioa: []A [ IR ( IC 146 <br /> 11 Excavation: (=ais, ps ,siippino cave-ins) ( aar <br /> [ I :'andlin; and Traasrer of a Hazardous Substance: ( Safe-7 gia:.ses/go-les <br /> (F.-e, ezpiosions, erc) [ I Smell toed/shank shoes or boors <br /> ( j Confined Space er*..y: (esniosions) ( j :.-&=e remrdanr cove-alts <br /> r, J neavy ecummeyr (physical injury& nava resulting [ Hear-;mg prarec='ors <br /> or moult_- eauipraerr) [I T7ve <br /> ( I IRspiraror, circle: APR.. or S3A <br /> [ I Ouse_ spe=ry A/P car-,..d-.e: <br /> ( J Sare_y vest <br /> 7. Anticipared Biologics 'r'a�-^s: ( J Two-wzy cor.^•_umcamon <br /> ( j Snakes [ I Insects [ I Rodents ( ] Poisonous Planrs <br /> ( J Orhe_/UnImown (specify): PART IV <br /> PT A.N APPR.OVAL <br /> 8. Naf�tive (provide ail information which could inmac Health <br /> and Safe y, a g., ?owe-- I-L-es, inregriry of dices, fe—in, etc.): Plan Prepare; by: ' Dare: <br /> Play a.Pproved by: D <br />