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FOSSSite - Specific Health & Safety Flan <br /> INF IR AST RUCTURE1 Job # !q ✓� 2 L/ <br /> Customer: klil l P. i vzrn��y�pJ Date: /J91 <br /> J 91 / 200 Z <br /> - t_ <br /> Business Type (Industry): ✓ulisp,L61 <br /> 1. Site Information I f <br /> Address: 3032 S . {E� V1c�2Xt� (� ��oc le io�� CA <br /> Contact: A✓td u W I )ood S Title: �� Phone: n2h(o -g1g6-0K$J <br /> 11. Emergency Contacts <br /> Regional Foss Office: A �a mle CL Spill/Release Contact: Z , <br /> Customer Contact: Name: IGrYP,w Phone: <br /> 0q8t <br /> Nearest Medical Center (Emergency)Telephone &Address: +• a5enk S -n'A &A CG'-t <br /> 3132 W . Aavckck �Skx , CA % I y -Z sy <br /> III. Project Summary Ste A4 p A4Ac"/� <br /> Description of Material(s) (Proper shipping name): 0 i eCp- I )L <br /> Is the MEDS readily available? qNo ❑ Yes (If so, please attach) <br /> Scope of Work (Check all that apply): <br /> ❑ Labpacking ❑ Haz. Cat. ❑ Overpacking ❑ Bulking <br /> ❑ Repackin ❑ Sampling ❑ T& D 11E R <br /> Other �o <br /> Site Hazards (Check all that apply): *- Requires H & S Officer Review <br /> ❑ Corrosive F Flammable ❑ Sharps ❑ Reactive <br /> Woor Lighting 1¢'Poor Ventilation ❑ Cold ❑ Heat <br /> ❑ Biohazard* "iDxygen Deficient*Confined Space* ❑ Radioactivity* <br /> 11 Carcinogens* 11 Explosives* Aoise ❑ Electrical <br /> KOther (list) -5 �.raCC'c insTript tic <br />