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S,�V IOA_QUL f C0IFY7Y- EVV71RO?VTMEN- FAI, H L7H DNISION <br /> SIT= iE L7H .AND SAFETY PLAIN <br /> ART I ?:SRT II <br /> GaN, ERAL Slir. IN-FORMAI LON irVALUA=ON OF PaT?r-'IAL I-r.AZARDS <br /> L. Sice Name: \ S' �-�G��O �" J' I. ChemicaLs IKaza_rds <br /> Address: Carc�nogPens: C-94--- � <br /> Contac= ?°_*son: n, C otione No. ((jCar osives: IZJ <br /> Sweeps Number <br /> Proposed Date of nvestigadon/inspe ton: ! ( j josives: <br /> �1' ammanjes: <br /> 2. DesCipdon and brie:har aave of imme ton ac-vity- ( j inorganic Cases: <br /> Mew UST ssm1jarion [ I UAR iavesdga&n �femjs: .cL <br /> ( I :amk C:osure in ?!ace [ j Tan-k/Pipe Repair [ j C—:dize_*s: <br /> ':::,ar-k/°ipe Rioval [ j ;le-e=cavar-on [1 PCTs: <br /> ( I i_rstallarion of 3orsgs/Moniror�ng'Neils <br /> ?ART M <br /> 3. Scut Sice im*o=adon: �O REQU= P7RSONA.L?ROTrCIVE <br /> T ark Vo. Tau=t Capacty- I ,�,Ga� EQUIPME.Vi <br /> Tank Conranrs: M n ue�'P�atc t Ag-- <br /> Ctne_r: -3-i.c. 4L— i. :Monitaen =quitar: (note: Monkormg <br /> m-zs :.ermt:st .ors e ued 5or ajl oper-ations <br /> b <br /> ?. -, /pe of Cpe_--ation: ��2s Lc.V S Jc-,?17 j C)-Yl }Fess amroprace donate or=es..::C_ons are <br /> a- -provided) <br /> Rei ease :_srorkomDtsvoje Gas/OspW yfece_r <br /> -Adennce of leaks/sail con*aminarion: i 1 Dece�ar Tubes (Soeci-: <br /> Doc,=emred Grou-ndwarer contam:nadon: j `:z i NO ( j ?hotoiorl=r-or: Deeec:ar <br /> 3ack. ound and des=t on of any previous ="'glat:on [I C.,—,=c Vapor:maiyze <br /> or sped/- <br /> �anlrorr�g 'rS� e^.rS Zre maL :S2!1, <br /> -anomie or actmrr/area :esC.:c_oas: <br /> 5. ?ocen-iaj :.ealt i and Safer) <br /> Physical Conce_^m: (cYec't ail Lar appiy& descDe) <br /> ^est or Coid S4ess: of Chigb. ambi—:emp.) <br /> Noise Source: ba C }ze- <br /> Z. ?�=gnat ?-oce e .^uipment Y'�D <br /> [ I Csygen D -c: <br /> eency- Ltvel of P.-oce ton: [jA [ JB gC <br /> cavamoa: (fails, ups rsdupin cave-tns) :3rC hat <br /> Handlin; and Transfer of a Fazardous Substance: asses/gog-es <br /> (Hre, espiosioas, ere) ,Q Scee_i wed/shnrk woes or boots <br /> ( 1 Conned Soace en=-)r (espiosions) ( j :lame retardant coverai?s <br /> e=03near (Pagsical injury 3c sauma resulting ear g pmtec_on <br /> om moving equipmenr) Tyvek <br /> ( I Resairaror, crcie: APQ or SC3A <br /> [ 1 Other, specify A/P c =—dge: <br /> .Safety zest <br /> 7. ar e(:ipaced 3ioiog-,c•..I Ha=rds: ( j Two-way cam.^uaction <br /> [ I Snakes ( 1 insets ( I Rodents [ I Poisonous ?lana <br /> ( I Ot Ger/UnIciown (specify): ,11)4) PART 01 <br /> PLa-i APPROVAL <br /> 3. Narrarive (provide ail informadon wbic:i could impact Healer (� <br /> 3I1 Safer), a ? 4d�# <br /> .. Jowe_r Lines, Inregr_ry 4r a1$es, :e---=_ etc): ?lar_ ?repare� b Dare:�� 3 <br /> l - t G f �� <br /> G ?Ian Apgroved ay- Date: <br /> '?2081 (2/7/92) <br />