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SA-NN :OAQUZ+`I COU?`!T`: =VV RO?v11Lv = ,^: DIVZSiON <br /> SITS HEA H A-ND SAFE=I ?L N <br /> ART i °ARTII <br /> C- SAL S'E a4TORMA CN nIALr "ION OF P07=11AL F-AZARDS <br /> Site Nave: g(,(a tAa /tet/ ' Che=ietls Faza-res <br /> Adcress: -:?/A7 E. "Kcaz Zor_s. <br /> Contac:?e_'Soz: ?Fane No. C I C,:---jSi7es: <br /> sweeps Nt:zzbe_ <br /> ?'noosed Dare of Z=piasivem <br /> [7 =la==a,ier. <br /> 2. Desemeon and one:az= a of==e--on moor: ( ] faorn= Laser <br /> [ ! New US Lsr1t�r va [j Ue1R luves-.sgamn [j Mens <br /> [ 1 Tank Coss--t in ?!ac [ ] Tank/?F?e .R=w (j Ozicz_-r <br /> ( j Tank/?toe RA=ovmi ( j 3e-cxx;mz •, [I oCi's: <br /> ( ] insrzilarion or 3or.—s/Mnaaotatr Wei <br /> PART M <br /> 3. Soe^sc Sire l3ror_ati= QLAv'J P'RS,NrQ .PRO GC lV= <br /> ank Vo. -a=e C_-pac r. L-- EQUEJ& "'V . <br /> Tars Cone=m: Tz s Age- <br /> Otter. = �; <br /> a==e= (note: Moritvr <br /> gSSCSSYnu -s-=.e= ns Se sec [or idii ope—z=c s <br /> Tyne Of vae_mnon: M ,-I—m.m=t;rare?sonaae or-:-s---Gore are <br /> Jrnvlde ) <br /> 3eiewe Fsor/: (70=1 ale Gas/0r7g-_- Mete_ <br /> _vice-_ of!emks/soil con--z—o= NO ( t Det_-=r Tabes (Soecf7) <br /> Doesaeated Grotmawate: :Onr•*-=moI_'- C I -rte C j VO [ j ?hocoion=Lon Dec--=r <br /> 3actvro=c and desC7ton of any previous L". --gamon (j Cry-sic Vapor?=atycer <br /> or incidence: A +",A-00-, Ot. soe=q <br /> if *TM+r+g r=ems are --ot sed, <br /> madon-ie or a=7,=/rr..a res=ors: <br /> 5. ?vicenmai Heid: and Safe_ry <br /> ?'_ysiml Canc'=s: (c=e=r ail ^at woiy & desecae) <br /> -ems or Caid SL-°ss: °Q C^iga a cbi=-- ®-) <br /> >t:Voise sour:_ h is r(��bf . 2 9^anal ?rocecve :-^uivme- <br /> l" I Or/gen De=demo: Lave of?roce_on: [IA C IB C IC /(D <br /> cavacon Muls, =)s flipping cave-ins) C j :mrd har <br /> [ j Haneling and of a razardous Sub=nr- [I Safety asses/wWes <br /> (Er e=iosiors, ere) [ j Ste meds:mk shoes or boom <br /> ( l Contiaed Soar_ =-7. (expicsions) [ I :areae ce=r--= covemis <br /> >a'...eavy em==ent (paym=i im s & ._a= rewiring C I ='ar proreccn <br /> --om taavxgpccs) le 11.0 2— [1 T77es <br /> [ j 3espiracor, tree: APR or sC3A <br /> ( I Other. specify A/? <br /> C I Safery vest <br /> i. A dciDared 3ioior c -,,,.,rd [] Two-way cor=^^ Om <br /> f j Snakes [ ] secm C ] lodenm C .1 ?aisonous ?lana <br /> [ I Oc^.er/Gnimown (specify): PAR:V <br /> PLAN APPROVAL <br /> 8. Nar-amve (provide ail fC=zdon wcic-. could �=aG F=n r= <br /> and Safe 7, &r_, power-es, TZ--,t7 Of^_KMS, :emir. e_'c.): ?!a-- ?rmared by:0�DUE 9 /4 99 <br /> ?!z?.oproved by: Dare: <br />