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JOA iY �-VT1 ,0 t�v1~N'AL A. i= DiT/ZSiON <br /> SITE IEAL.TH A:V-D SAFE= PLANT <br /> PART 11 <br /> C AL S"L IIvTORMAi10N EVALIIA�ON OF PO 1 T uAI HAZARDS <br /> :. Site Name: N SDA Q� L-r !- Cherials ciaza'ds <br /> Address: 1 7 9 00 S aM Ca*cnoge�: <br /> Conme Person: Phone No. Cat olives: <br /> Sweeps Number. ms`s' <br /> Proposed Date of avesrigarion/nrspec fro= C ] �rrlosives: <br /> 2r^ MDLes- <br /> 2. Desdpcon and 'brief nz�rive of jasoe^'on ac=vitt': [ ] Inatganic Cases: <br /> ( 1 New UST imst: anon C l UAIt lbvergarion <br /> C j Tank Clos= in Place [ ] Tank/Pipe Repan [1 Oxidiz-e <br /> rs: <br /> ( ] Tar V.Dirie Removal [ ] 3e-mcx7=on C 7 PC3's: <br /> ( ] insallarion of Bor=gs/Monitorag Weis <br /> [ ] �Lw kbPoaiu. ??RTiL <br /> 3. Soec._"c Site in'ot---aria= REQTJ= P=ZSONP.L PROZ=CIIVF- <br /> Ta Tamik Capac r. EQ ii MaTIT <br /> Tac:c Conte_ars• Ta^_k Age- <br /> CLZ_ !. Monitor^g :quipment: (note: Moctoruiv <br /> ==-ems mut be used for ail opemrions <br /> Type of Coeacon: (�!�eA�� unless annronrate zrionaie or-es=:C_ors are <br /> provide <br /> 5. ROiese Fustorl- C I Combusnble Cas/OX79e- Met= <br /> =ridence of le_ks/sail conr=i^,rioc: XQ JIIs [j NO ( ] Dere—r Tubes (Sbecfy) <br /> Doge=red Crourdware_- contaminario= C FMS S [ I \10 C I photoior;�don Detector <br /> 3ack=und and deseipcon of any previous _^vesrigarion (] Organic Vapor Ariyc` <br /> or incidence: � Gln��hi AfA SPM C ] other, speciy <br /> fDY�I •YA If=nirO,— <br /> L_g ' -'L'e^-rS are nOL MSEC, <br /> zcorale or acdm#/area reser cors: <br /> 5. Pocenrial =ea!ta and Safe_ry <br /> physical Conce (cae--', all that appiy & descbe) <br /> -ear or Coid .S�ess: OF ('biga ambient ce=P-) <br /> Noise Source. 2- Personal proce�ve c^uipmenr <br /> ( 1 Or/gen De^ce=cT Level of Ptore=o= C ]A ( jB ( ]C P <br /> ( ] _avario= (fans, T-ps Slipping, cave-ins) >ssQ -,ird liar <br /> .angling and T-ansf- of a razazdous Substance: bIrSafety Biasses/goggies <br /> (E E, r�iasiors, etc) K Sreei roed/shanic shoes or boots <br /> [ j Confined Space end (esniosions) ( ] :lame remrdant cove-alls <br /> C l ^'',w equipment (pixysia injure& �r..r.a resulting QQ Le=r:`jg Prorec_on <br /> from g e <br /> rovinquipmet) ( I Ty°ek <br /> ( ] Resoirzror, Qee: APR or S(:3A <br /> [ t Other, specify AAP =rC.- e- <br /> Safety vest <br /> 7. Anticipated Biological c:azards: ( j Two-way com^_-=czr-on <br /> [ j Snakes [ 1 insets [ ] Rodent [ ] Poisonous Plants <br /> [ I Oc^.er/Unlarown (specify): PART iV <br /> pT e,N APPgOVAL <br /> 8.tYa•-arive Cprovide ail informarion wilicz could impact Heal <br /> J¢ Datz: <br /> b <br /> and Safety, eg., -?owe-- L—:-es,, ategrs/of dice, :e-min, arc): ?!an Prepared Y• 1 2g' <br /> p!an Amroved by. Da I ia00 <br /> =7308! (2 /92) <br />