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S,A X JOAQLZN COL-N"i Y. EN,-VUtONRyaN � A.L I=AL.'i DIVZSiON <br />SITE r!- -A.LTH AND SAFETY PI -k .,N- <br />_E r.. AL S, =z INFORMA-ZON <br />zVALII =CN OF POTEN UAL I -A=S <br />i. Site Name:C rr 'fes_ ' `(, +T LIN & � <br />1. Che_—ieals H;g— ds <br />[-1/Carcnogers: <br />Address: 04C-3 15 (HILL6 L Lfif_> <br />Contac P _-son: S� (�'E C_, pNNG r\; Phone � io. `3;1 3S_7& <br />L ] Cntrnsives: <br />Sweeps Number: <br />L I Dum- <br />Proposed Date or investi arion./inspec on: <br />C4, Plosivs: <br />? Descn-Drion and brie: nzrnra :ve of ins?ec^'on acriviLy <br />L ] Inorganic Cases: <br />[ 1 New liST T^ i anon [ I UA.R Invesrigation <br />L ] Memis: <br />[ 1 Tank C:osu-e I:-- Place L I i�-�P=Pe '?air <br />L l O 3: s: <br />[ I Tap..k/PiDe Reroval n <br />t <br />L 1 Pa's: <br />[ ] r anon of 3or'm;s/Monitor=g <br />??RT IT, <br />3. Soec_^"c Site ��*ormarion: <br />R..QL�F= P-Si�N�I- D�OT�CTIVE <br />-z�;c NO. Tantc G patty <br />EQUL��iENI <br />Tan:K Conrears: ian_'Kc Age: <br />_ <br />Monitor---�DLZe^-L (note: Ao *L�LOr'11, <br />OC�le� <br />_-=;,��*S X1:5: be use.^ :OZ aL ODe=-_iOnS <br />L* less app=priace rationale or=es_:c=ons are <br />-. Type of Cues' oLl <br />providea7 <br />L I ComousnDle Cys/oxygge_ Mete_- <br />S. Release History. <br />�vide^_ce of leaks/soil ccrlmm i*iarion: L I '--S [ 1 NO <br />(] De::e=or Tabes (Sperry) <br />Doc=�. ^t=d Gtoundwatz-- contamination: �i0 <br />( ] w oroion=ation Detet=or <br />3ac:c;o=d and desccDrion of any ?revious `cvesrigzrion <br />L I Or; sic Vapor Anaiyz�*' <br />[ 1 Otrer, s?ecfy <br />or incidence: <br />It monitO.yg in �- +,.I.'+e^.rS are uOt ':Se^_, <br />rationale or activity /are= resm=ors: <br />S. Potential ^ealtL "end Safer) <br />?bysic_.1 Conc_=s: (c= e�-'r all cat apply & descDe) <br />[ ] ::ear or Cold S� s: °P Chigh ambient te=D_) <br />_ <br />2. personal Protecr:ve c.;n'pme= <br />'Vo <br />L'Ir=ile Source: <br />Level of Pore _on: [ ]A L IR L ]C L jD <br />(] Oxygen Denceac/ <br />I ] _ cavadon: (.tails, a Ds slipping, Cave-ins) <br />[vj :1'Sd IIaL <br />[Safety basses/;ogees <br />(c,]' Handling and Transfer of a Hazardous Substance: <br />Lt�`Steel coed/shankshoes or boots <br />(E -e, es?iosiors, etc) <br />[ j ame cove�a!Is <br />L I Confined Space enc{ (explosions) <br />(physical injury & -,-a a resulting <br />g prorec-da= <br />L I Hezr_i Protecroa <br />(Ly.: eavv eatu-ome= <br />[ ] T7vek <br />?'Om =ovin, eJt1SDII�L) <br />(]-Rz=irator, crcle: APR or SC3A <br />A P ca �-d; e: — <br />[ 1 Oche--, specify <br />(­Y'S,aety vest <br />o <br />7. ric pared Biological rages: <br />�� <br />(] Two ==-way co niczrion <br />[ j Snzkes [v]l L^sects [ ] Rodents [ ] Poisonous Plants <br />PART- v <br />[ ] O[ e_-/Link:lo�vn (sDe=iy): <br />pT eN APPROVAL <br />8. var-mrive (provide ai? jn*otTL.arion which couidDac F:ea1 <br />Prepared by. f0, ,VM" Dare_ b 6 <br />and Safe -pry <br />y, e g., ?owe.- Les, inte�y of df.�ces, te^ain, etc): <br />plan approved by Daze: <br />:-:-13081 12/7/921, <br />