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SA`i 10.4QLIN COL-i`: =VV I RO-N–NMti ,. ==4L i� DIVZS ON <br /> SITS =; LITH kNO SAF-EL-Y PLA N <br /> "RT i ??RT U <br /> C=V�AI Sl t IIviORM�LION =Y_9I.0-A=ON OF POTERN uAL HAZARDS <br /> :. Site Name: oM , �. veli i (d C, ?. a�e leak Hazards ---� t n, USW <br /> Address: �/ n .C� it/U O.s � IIQ... G(<<LQ,�-� Cy �_*c3oges: .Elon�n ew <br /> ., ,9 <br /> Contac?° son: �r� _a,�L+a pone No:�1 -�gb�f Cl Corrosives: <br /> Sweeps Nwtber v IfKb isa: <br /> Proposed Date or=vesc2tion/!s?ec=aa �-DO ( j -plosives: <br /> 2 Desdpdon and brie==neve of inmec^on ac=vicy. ( ] Iaor.-dr-ic Cases: <br /> C 1 New US i stEIlacon [ ] UAR lnvergmdon (] mpmis: <br /> C 1 Tank Cos•,_-e ' ?lace (] Tazk/9:oe Re?atr [ ] O.-Idize_-s: <br /> ( i -an4/Pipe R•=ova! ( j 3e-metvzt on (] PCB's: <br /> [ ] i^.su larion of 3or-gs/Monirorng Weds <br /> P ART u <br /> J. Soe_"c Sate o. �r - REQrj= PERSONAL PRO- .m=I -- <br /> ,ar_r Vo. aoD Tank Capac*y - EQUi? T <br /> Ta^r Conre^a: TaTic Age.. / <br /> Cth ., ,0 0 - H 11 WAS 71= 7(j 1/ I. Mo.itormg =gniptaenn (none: Mon?cor g <br /> Abin -� f �� 7 �/ s� °^a must be used or aii ove=_ars <br /> ype of Cpe?_cr =Iess approp-:ace-comae arrest cors s=- <br /> e w4,5fie fG7 tx f S i A- provided) <br /> fele se F mr/ ( ] Combcrsecle Cas/Or/g•_ Meter <br /> vidence of lealpec/saII chef ^ ^a^on: [ I =s [ ] NO ( ] Dere=or Tabes (Specify) <br /> Doc—e_^-red Groundwater com-roinados ( 1 `rte C ] NO ( 1 ?hocoior con Dececor <br /> Background and descpdon of any previous vergzcon [I Crg=c Vapor?=aiyze= <br /> or incidence: [ 1 Other, specry: <br /> If t=onlro22g ir= are _or •;Sed <br /> radorme or activiry/area *est cr_ons: <br /> 45L l+ D S-4&4- <br /> 6. <br /> . Poce_^eai 'Healr and Safer/ <br /> ? cm Cane^s: (ce ail =r apply & descDe) <br /> ( eat r Coid Sc ess: >/b0 ° (nigh "6i,,rexp.) <br /> a Source: / B<: o � - <br /> 2 P_scnal Prore—ve cgaipmp- <br /> ( 1 9--/gen De=drench Level of Puce'on: C]A C la C IC KD <br /> ( imcavanon: C a1S, =05 shoving, cave-ins) 'W2rd liar <br /> C I -angling and Transfer of a •r_arardous Subscance: J>J�Safecy a sus/gog�es <br /> (l=e, eSPlosiors, a:e) ,e_i toed/shank shoes or boas <br /> 114 Confined Space e_-=7: (esniosions) I Fame remrdanc cove.-ails <br /> (�-caw egaipaenr (physiml #jray& za,.,,,a resulting =crag praredon <br /> =om coving KS :Y-A C I 77ve <br /> ( I Remiracor, Acle: PPR or SC3A <br /> [ 1 Over, specry A/P <br /> ( j Safery ver, <br /> 7. 3ioiog,c_i Hz=ds: IVoN �- ( ] Two-way communication <br /> C I Snakes ( I linsecrs C I Roden C I Poisonous Plants <br /> [ ] OLer/[nlmown (specify): PPR N <br /> PLAN APPROVAL <br /> S. Narradve (provide ail in_or_adon which could impact Health- <br /> and <br /> ealthand Safer= ea, power Les, inregrsi of d_¢es, -m---min, ere): ?!a= Prepared b�Date: <br /> 1 LAi� � cLLL00 J X I/ / l(�Q <br /> plan Approved by: `� Da-:•(�-f-'-- <br /> _-2308" (2/7/92) <br />