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S,kiN IOCQLZN C0ti-NTY-=N7IM0N_� -r.AL >E kLTu DP!TSI0N <br /> SITE HEAL.TH .JuND SAFTY PLAN <br /> ?ART 1 PART II <br /> GENERAL SlT3 INFORMAnON EVALUAZION OF POTMAL Is.AZARDS <br /> Site Name: i 1- Chemicals Hazards <br /> Address: <br /> ,gCarcnogens: <br /> Contac_Pe-Tsars: Carrosives- <br /> Sweeps Number: C I Buszs: <br /> P:•oposed Bate or iuves igat:oa/Iasaec on: �� iosives: O fi4� <br /> �_auzmables: <br /> 2. Besciption and 'brief narrative or inspeedon acd itp: [ I [norganic eases: <br /> C 1, New UST Insmilar oa [ I UAR Investigation [I Metals: <br /> E I Tank Cios a in Place [ I Tartit/P-'ve Repair 'S- <br /> �.Tan. [ I Re- =cavatian C 1 PC3'3: <br /> C I installation of Borinp/Monitoring Wells <br /> ?ART iII <br /> 3. Sbeciac Site information: RcQU= � <br /> PE—RSC .L P=3OT='-GTIVE <br /> Tank To. 1Tani{Capacity. EQUPME:Yi <br /> Tank Conre-ars: ty,— Tank e! <br /> Other: 1. �tanitotm.g Saulpmer:L (note: Ytoz,irorng <br /> r = s=-=menrs =list :)e used ar ail operamons <br /> ?. Type of Cpe^atioa: ess approorate:azonaie or=es :c_:oas are <br /> provided) <br /> S. Release �Esrorf- �b Combuseole Cas/0s79en Mere-r <br /> S,ridence or jeans/soil conm=inarion: ( I ES C : C I Deremor Tubes (Saeci y) <br /> Boc-rmented Groundwater contamination: C I YES C : O [ I P�+ataioaizaz?aa Bere�ar <br /> Back round and des=t on of any Previous i-_7esrigaz oa C I Cr'g =c Vapor Amaiyz` <br /> or incidence: C I Owe, speciy: <br /> rf,y onitoriag last==_ e= are pot sed, <br /> mdonaie or acrivirir/area <br /> p. ?ocennal r:eaitd and Sater7 <br /> ?hysicai Cone.^..-s: (check ail ::at apply& descfae) <br /> C I leaf or Coid Suess: 'IF Chigh ambient=mp-) <br /> r4Noise Source-- Alu 2 Personal P:rocec&e Fa uipmenr <br /> CI—eve- of PTotecon: C IA C jB C IC <br /> . <br /> G .YCavadon: (falls, asps sdopin- cave-ins)® R F".ard Bat <br /> C j Handing and transfer at a Hazardous Substance: U Safe-7 gip sses/goggles <br /> Handing <br /> (Ste, explosions, etc.) <br /> Szeei toed/shank shoes or boots <br /> [ I C I came retardant coveralls <br /> Confined Space eazy: Cespiosians) <br /> Heavy equipment (Physic ai :musty 3c rag=a resuftmg [ I e g oa <br /> From moving equipment) E I Tpvek <br /> C I Respirator, circle: APR or SC3A <br /> ( 1, Orhe_r, specify A/P c=—,.:id-,e: — <br /> CI Safeey vest <br /> 7. Anricipared Biologwai Hazards: C I Tomo-way communication <br /> C I Snakes msec_= C_Rodents E I Poisonous ?!ants <br /> C I Other/ vn_ own Cspeciry): P.�T iV <br /> PLAN APPROVAL <br /> I Nara&e (provide asl information which couid spam F teaits <br /> and Safer!, e.g., power Lines, inters/of dikes, :e * ain, arc.): Plan °re°Pared 5y. mate: <br /> AW4 <br /> Plan Approved by- Date: <br /> 1.=23081 (2/7/92) <br />