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SITE SAFETY AND 1. Incident Name: 2. Date Prepared: 3. Operational Period: <br /> CONTROL PLAN2 GTime: <br /> ICS 208 HM L 'ZL('N� / Zit / I ) <br /> Section I. Site Information <br /> 4. Incident Location: 5T <br /> Section II. Organization <br /> 5. Incident Commander: 6. HM Group Supervisor: 7. Tech. Specialist- HM Reference: <br /> I't/l P}TT 5 / ZYT.1— D l:J t G " L+ r-)o 5 �Y J] L.-A�j 6 i At l+J csrTO <br /> 8. Safety Officer: 9. Entry Leader: � 1 10. Site Access Control Leader: <br /> C"�ILi�-� N �� 4-T—F 5 14-t)-fu- <br /> 11. �Agsst. Safety Officer- HM: 12. Decontamination Leader: 13. Safe Refuge Area Mgr: <br /> 14. Environmental Health: 15. 16. <br /> Q-03C✓� &V('/;Z <br /> 17. Entry Team: (Buddy System) 18. Decontamination Element: <br /> Name: PPE Level Name: PPE Level <br /> Entry 1 l) • (� i µ,,7 N Tj Decon 1 <br /> Entry 2 t, . L4�S h Decon 2 <br /> Entry 3 Decon 3 <br /> Entry 4 Decon 4 <br /> Section III. Hazard/Risk Analysis <br /> 19. Material: Container Qty. Phys. pH I IDLH F.P. I.T. V.P. V.D. S.G. LEL UEL <br /> type State <br /> D/Ic 1—V L1 T-✓t-ni\L 5 LAC - <br /> Comment: <br /> Section IV. Hazard Monitoring <br /> 20. LEL Instrument(s): 21. O, Instrument(s): <br /> 22. Toxicity/PPM Instrument(s): 23. Radiological Instrument(s): <br /> Comment: <br /> Section V. Decontamination Procedures <br /> 24. Standard Decontamination Procedures: YES: NO: <br /> Comment: <br /> Section VI. Site Communications <br /> 25. Command Frequency: 26. Tactical Frequency: 27. Entry Frequency: <br /> Section VII. Medical Assistance <br /> 28. Medical Monitoring: YES: NO: 29. Medical Treatment and Transport In-place: YES: NO: <br /> Comment: <br /> ICS 208 HM Page 1 <br /> 3198 <br />