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SAN IOAQ N COL:NTY EN- VIRCN. " L�'iAL. F AL'M D77MION <br /> SITE T,-7AL rzl AND SAFETY PT—AN <br /> ART I <br /> PART B <br /> Gr1vER.AL SITE IN-FORMAilON EVALUATION OF POTaMAL F-A=S <br /> _. Sire Name: - 21l 1. Ch caisr'azards <br /> Address: C Carcnogens: <br /> Conrac=?erson: Phone No.mo.�ti 2.-gp (j Cot;osives: <br /> Sweeps Vumbe= <br /> Proposed Date or xvesri;ar on/b=ec^on: [ ..iosives: <br /> [ =lam ables: <br /> 2. Descipdon and 'oriel aariacve or:ripe yon Inoganic Cases: <br /> ( 1 New UST Li^ d 'on ( I HAR 1 7 agaMOn [I Memis <br /> C 17 ank Clos•.ire in?!ace ( j T :pe Repair [I Oxidizers: <br /> ( ank/Pipe Re✓ovai cion C I Pa's: <br /> C I instaRarion of 3orng3/Moniroring Wets <br /> PART 0i <br /> 3. Soecinc Sire [nforaado= RvQTJ= P;ZRSONAL P:LOT.-= <br /> .a nk No. Tank Capaciry. /0 4 EQUIPMEYi <br /> Tank Conre^_rs: 1�Q_ _...�' Tanis Age.. —F <br /> Other: --- ? Ltonirorin Equirmenc (note: Vonzcorn; <br /> ris -=ears 3ust oe used 'or ail operations <br /> ?. Type or Goe--az:on: wJ, '-fess DroDrace=cora:e or�s�:c=ons are <br /> Oro e�7 <br /> 3. Reiease Hsstorj: l Combuseble Cas/Oxygen. Meter- <br /> wrideTce of!e`.,cs/sari contmai naz on: Jc'cS ( j ( I Derecc:eor Twines (Scec*y) <br /> Doc-=enred Groundwace_r con 7 adon: f I 'SS VM0 ( I ?hocoiorizar?on Dece=r <br /> Bac?c;ound and d c::pt on of previous iavesdgacon (j Cr;amc Vapor snaiyzer <br /> or iric deuce: ® s ?�.� C I Other, specq:j <br /> If=oniconng Ls—,-=ears a_ <br /> *s <br /> racos_aaie or ac^virr/area res�:c_oas: <br /> j. Pocendai Heaidl and Safery <br /> Pays ai Cance.^-s: (p erk as char apply& desc-De) <br /> [ 'cleat or Coid Sins: °:= (high amniers <br /> ( J Noise Source: 2 PersoIIai ?roceyve Equipment <br /> f I O en De=peau f: proceyoa: (jA (IB CIC [ <br /> [ cavaL'on: (fails, TDs Slipping, cave-!IIS) ( I Bat <br /> _: <br /> [ I Handing and Transfer of a F-izardous Substance: [ Sare_y asses/gog�es <br /> (Bre, expiosions, ecu) C I Step coed/shank shoes or Boors <br /> ( j ondned Soace en=/: (expiosions) ( jretardant coe+eraLs <br /> C4,'-eavy e=-o=ear (physicii iajtuy& .TdLma resuiang ( mIg-9mcec^on <br /> sora =oving Tyvek <br /> ( I Respiraror, tee: APs or SC3A <br /> [ I Order, spec*: AN. car,--.d;e: <br /> [ I Safe_:vesr <br /> 7. Andcpaced 3ioiogic i cia.rrs: C I Two-way cota^uniczdon <br /> [ I Snakes C I tnsecs [ I Roderim ( I Poisonous Plants <br /> ( I Othe_r/Urilmown (specify): ?AR T IV <br /> PI-1.N APPROVAL <br /> S. Narradve (provide a l infam--adon which couid sipacc Ream <br /> and Sane^l, e.g., power l Les, �re;riry of d:.+ces, ce^_ain, ecu): ?!a.^.?re?aced 'oy <br /> ?!an Anoroved by: Da' <br /> Z':-:23081 (2/7/92) <br />