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STI= =ALTE AN-D SAFE= PLA-i <br /> ?A-F,7- = PART II <br /> C^NE-LAL S1Tr. W ORMATION F'V-ALUA=ON OF POT=NTiAL F-AZARDS <br /> _. Site Namne: �• ChP^*;cals 'r'a res <br /> Address• [? C`cno gA_.:s: <br /> Contac P_-son: Phone No. [] Corrosives: <br /> Sweeps Nunbe_. C Imo' <br /> Proposed Date or±.*vesrigatron/•!=e-'on: C I —plosives: <br /> C I ies: <br /> 2. Desciption and brier na_—dve ar ssvec-=on ac=vitt' C I (ao rgar-ic Gases: <br /> C ] New liST lnsmilarsom [ ] UAR Invesrgadon C ] Mecais: <br /> [ 1 Tank Ciosu-e i- Place ( ] Tank/Pipe Repair ( J Cad==: <br /> [ j -a`k/Pipe Rj al ( ] Re-�-=C=:on [] PC3's: <br /> [ ] Tr anon of 3or�=V/Moritar-;-ag We_ls <br /> PART 1L <br /> 3. Sce--'^c Site REQTjM P= <br /> _ZSCMAI Og F <br /> ..k No. ark C_pacry: :QU�MFLNi <br /> -ink Conte---=: T=Age: <br /> Ctle_r. '. LMonlror-* ^quiDIIertr: (note: Mor-roti o <br /> 5'-_.em-ts ':SL be Used:or aL coe_.c <br /> ;JDe <br /> of Cpe_ar_'c= '"*less=Droamate:adomaie or.es'c-=ons are <br /> provided <br /> Release Fistorf: C I Corlbusz�ble Grs/Ozygp_ <br /> Mere--of leaks/soil coarn-imadon: NO [ ] De'_ecar Tabes (Spe^i-/) <br /> Doc ma-ared Gcot^_dwate.- corrminat on: j YIS ( J NO [ J ?hotoio -r on Detec:ar <br /> 3actg=ound and desen_tion or arty Previous =vestigation [] Cr; *c Vaaor? aiyze_; <br /> or incidence: C ] Otte specry <br /> if=onitol-- i=---errs are LoL ::sed, <br /> r~_orale or acr*virt/area -esLrc_ots: <br /> 5. Poce.^_ca1 -ea!t and Safecy <br /> ?bysical Conc_^s: (chert ail mr apply & descpe) <br /> C ] *Hear or Coid Stress: OF (nigri abient te✓p.) <br /> ( ] Noise Source: 2. Pe_r;onal P-ote-'ve c.^_Lir;me^_t <br /> C I C.;jgen Dence_gr revel of D--ore----;o= [']A' C ]B C 1C C ID <br /> I I -:cavanon_ (tall, -pssLDD�;, cave-tus) [ I :ata hat <br /> C j ::ana'ling and Ttarsier of a Haz=rdous Substance: [ J Safe-7 basses/;o des <br /> (Irre, espiosiors, etc) C I Steel coeds ank woes or boors <br /> C ] Conaned Space e--=T. (esniosions) C j =ane rerardant cove_-mss <br /> C 1 -eavy eault)=— (paysical =jury& ra=a resulting C ] ?egg protec•=on <br /> ort roving _amu ptrert) C 1 i7vek <br /> [ I Respirator, Acle: APR or SC3A <br /> ( ,1 Ouse:, specify Respirator, <br /> c==dge: <br /> CI Safety vest <br /> 7. anticipated 3ioiogic_l Hazards: C I Two-way cormunicarion <br /> [ j Snakes [ ] L^secTs C I "Lodemrs [ ] Poisonous Plants <br /> [ ) Oche_/UnknoLvn (spe`ry): PART E/ <br /> PLAN APPROVAL <br /> 8. Narramve (provide all :--Zor=arion whica could izpac mea!$ <br /> and Safety, e.g., Power Les, inregf=s/or dices, :e_r-min, etc): Plz<: Prepared by. Date: <br /> ?ray Approved by. Dar_: <br /> 2308: (2/7/92) <br />