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0 <br /> c��! J OA_QLM4 COUT LT i`� EN 4r CSN!! NTA, -z=-A= DIVISiON <br /> SI•:^ ='.'E'.?!TH :4.c�1�D S AFF 1 Y ?T 3Nj <br /> ?AR: r ?ARTA <br /> C"�Pr.: L SsTr IIv�ORM ON 3'TALIIA=aN OF Pa"12- 411AL HAZARDS <br /> _. Site Name: ? Che^icais Hazards <br /> Address. LN�n Czrc Log=s: <br /> Contac Person: ?hone No. C I C:arasives: <br /> Sweens Nu=be= C I Dtz= <br /> or000sed Date of west;atron/+speon: (I .iosives; <br /> 2 Desciption and brief n=m&e of imine-400. acrvitp: C I isoroank Gases: <br /> [ j New L'Si L-xaiJ2=on [ j [JAR mercis: <br /> ( 1 ?ank C:osu-e : ?!ac. ( j iaL*k/Pipe Repair [I Cxi'' "'s= <br /> ~( ,Tat=k/oipe R�e=ovai ( j 3e-�: varon [1°Q'r <br /> [ j irstz!lat:on or Bor_.,=/Mo Weds <br /> PAR: <br /> 3. Soeciffic Site r,_rot"atio .R��L7R� P._ Se^.Nr+L PBGT C'"Ii VE <br /> .k No-l -G.1043, ia^k C.zpad, EQUL� rI <br /> i ani Contears: Tank Are: <br /> C_;,p,.. Ifo.%tor=*=� srse� (�ore_' lrloz*=taring <br /> oe we: or ail opermoors <br /> wasps of^vper*3t:ot:: '=less=01 Ortate- O=le orr3__=oCs are <br /> -brovidei: <br /> 5. Reiease :Estor-!- [ I Carmbus^.�Ibie Gas/Oxgg Mi eter <br /> O:,7icence of?ems/sail vzmm:n-.r'on: * �.� ia1, :7) <br /> Doc=eared Groundwater c?n*-.zr".'on; { ; 7ems { 1 NO { I ?hotoionj—_,4ot: Deer <br /> 3ac:yotrd and des=- ran or=y arevious =:^vena g =on [i Cr;�ic Vapor a_�y= <br /> or inc deice: [ j Ot' r, sped.rr- <br /> 1=oaito=g i .,,=e= arca sot_sed, <br /> :� onaie or ac::tvi7/U--I -es l"Ons: <br /> 5. ?ocA.nriiaieait= and See^l - <br /> ?'^ysicri Conc®^s: Cc=ecr za cat apply& descse) <br /> I meat or Coid Sys: OF C:igh pie==M=-) <br /> :Noise Source: 2 ? monai :I=re--i _re z ipmerr <br /> ( j Oxygen Dence^_c7 � of PTote^on: C jA C IB C IC D <br /> j ?xcavation: Chins, =_-pps siippino cave-ins) j ::ard aat <br /> j -andling and of a ==Nous Substance: I Safe°y a es/;ogm es <br /> Care, exnlossors, etc) �,I Seer. coed/si:ank sloes or-boots <br /> [ j Confmned Soac_ 'e =7. Ce=iosions) ( j ::aLRe r,tr��rtr Covr'3I?s <br /> j -�.�vy ec==ent CPnYn=i injury& cis es resuirIng [ I -�'=g?rote on <br /> `roti =oViag z~eet) C I 77 e <br /> ( j Respirator, tee: AFR or S:3A <br /> ( j Other, specify A/P c==dge: <br /> [ I Szfe*y vest <br /> 7. an`#ated Bioiogi= =a:�•ds: (j .,'AM-wzy cota^tciczdon <br /> [ j Saakes t j i_.se= ( j Rodears [ I Poisonous ?iatxs <br /> C j Ot er/U imown Cspeci y): PART V <br /> PI-AN c1PPq®V?.L <br /> S. va_radve (provide a't '='for...amon wazcn cou:a mac mea!^ <br /> and Saie=7, e. -, ower. iaies, ;ate; 7 OL dB=,, c =xr, tc.): Pia.: ?.spares by �aLe: _ <br /> ?ice 4.°_vrnvea by: Date- <br />