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SITE DESCRIPTION (Attach copy of site summary, preliminary assessment, etc.) <br />Site Name: <br />J <br />Address: 4 cR c k C <br />Type <br />Waste/Slucige- <br />?<Soil <br />L.Trface Mater <br />- Number <br />Department of Henan Services <br />Toxic Suostances Control Division <br />State • of Catifornia-4-maitn and welfare Agency <br />HAZARD APPRAISAL AND RECOGNITION PLAN <br />Original, Exposure Records; Yellow, Site file; Pink, Division; Goldenrod, Safety Offi1 r <br />Datetb 6-4 <br />-1C)b v•-n Prepared by <br /> <br />Teleonone Number: t —3 <br /> <br />Emergency Room Phone: <br />f\ e_ r\D <br />Nearest <br />Site Operator/Contact: <br />TYPE OF INVESTIGATION <br />7(Surveillance/Enforcement <br />Permit <br />Site Mitigation <br />Abandoned Site Assessment <br />Z Hauler <br />Hydrogeological Supoor. <br />Otner <br />Does investigation require empioyee or site exposure in—oriftPfal;P"-- <br />77— Yes ANo <br />County Code• <br /> <br />Location: <br /> <br />Site Telephone No. IV 6 ‘(\ <br />SIC Code: <br />Estimated Hours on Site:. 0-2 D >2-4 E >4-8 El >8 <br />SAMPLES COLLECTED <br />E..Z-P.a.riUre Monitoring <br />tz SAMPLE SOURCE(S) <br />Waste Category/Type <br />Investigation Date(s): <br />INVESTIGATION TEAM <br />Name Affiliation Z Drums) 7 Surface Impoundment <br />.. <br />1. LDrr\F\ '-,,:'n ,.-1,,./t) r.:vc-_- Tank(s) ,_.., ' Run-off <br />A_- <br />-7 413 ----5:7-r7 ) <br />7: Sump/Pit Z Airborne Emissions <br />3. <br /> )rN, Illegal Dumping Z Otner <br />SAMPLE TRANSPORTATION <br /> <br />Yes <br /> No <br />Shipping Container <br />Absorbing Material <br />Common Carriers <br />D. O. T. Requirements <br /> r. J <br />Other <br />—Resoonsibiiity <br />Safety Officer <br />E. <br />S. Page 1 of 4