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FA <br />SII ti <br />??R .' i <br />GEN AI. S= <br />NaW <br />Address: <br />Contac ?e_=on:�` <br />Sweeps Nutaber. <br />P-000sed Date of <br />2. Deseipr;on and beef — <br />[ 1 New UST I-smIlation <br />[ 1 Tars Cos -,=e ?lace <br />[ ] Tarlt/Pipe Rte. =oval <br />[ ] I. s'•a!Iadon of 3or=gs <br />3. Sped..^c Site Iz*o =ario=- <br />. _mak No. <br />Tank Contents: <br />Cr.Ze_: <br />Type of Ope_raeca: <br />vide -Ce of le-'S/soil COMM <br />Doc--e--red Gro=--dware_- c <br />3ackg=ound and des=rion <br />or %ic_de ce: <br />5. Poce.^_-al ealtL and Safe:y <br />?tysiczl Conce_^__s: a <br />] wear or Coid SL=ess: <br />(] :Noise Sou—.= <br />[ j O.; fgen D✓ =*e -=T <br />I=:cavar on: (a!?s, —c-tos ,: <br />[ ] -angling and Transfer 0. <br />,E--, eapiosiots, ere) <br />(] Confined Soace enr7- (e <br />C I =eaw ea==Ol=t (Paysic <br />-ort roving -cui )=err) <br />[ 1 Orher, specify <br />i. am=�epaced Bioiogic_l ::air <br />,f j Snakes [ I Insets ( ) I <br />[ ] OL her/Un1ci0wm (specify) <br />8. Na*mrive (provide a l errors <br />and Safe:y, e g., Powe: Ices, <br />='23081 (2/7/92) <br />r <br />SIT=' F- � aLI=-i Ati4-D S?. =.1 Y I?LA v <br />Phone <br />Of inspe ton ac_.viry: <br />[ j UAR Iaves::garion <br />[ I Tan_k/Pipe Repair <br />[ I Re-��cavatoa <br />:arnz We is <br />Capaciry <br />I a=k Age: <br />1?Ton: (j f S (] No <br />aminaco= C j = (] NO <br />any ?revious investigarion <br />:!:at apoiy & dese=De) <br />°; (':ign arcbie�� resp_) <br />1DDir, cave-ias) <br />a Fa=rdous Subsance: <br />aiosions) <br />i! injury & r;au a re nEring <br />[ ] Poisonous Plants <br />waica could izapac: ea!tr <br />wr of di:Kes, _e -min, a:c): <br />PART U <br />E'VALLLA=ON OF PO=�vTiAL F -AZA MS <br />1. Chemo icals r_azards <br />C C,-- cnoge= <br />[ j Ca=osives• <br />CI <br />�r„losives: <br />C I Inor-garic Gases: <br />C I Merais: <br />C I C:ddize_-s: <br />?ART iT: <br />RF.QT-=J Pm-�SC)NA.L PR=Ci1V <br />SQU�3�LNT <br />yloniror*^g 7cuiprze^r (note: -mo horn <br />i=s==ee--= =,.:sr be used for ail ope:-,-._ons <br />artless aDDrooriare -zr:onaie or_est-:c_ons are <br />?rovidec� <br />(j <br />C=buszDle Gzs/Oz7.-P^ Mece.- <br />(J De:ecor Tabes (Specify) <br />[ I ?hocoioni-rion Decec:or <br />C I Cr znic Vapor A=aiyzer <br />(1 Ot ier, spec=T. <br />If r�OnSLOi:yg in �,�e^.rS are riOL =e,I <br />zno -aie or acrvirr /area rest-:c_ons: <br />2. Pe_=onal P--ore--:7e Ecui=p-r <br />L' t of ?:ore =on: ( ]A C IS C IC [ ]D <br />j Ham har <br />ety Biasses/goggles <br />[ Steell roed/s: an_k woes or boors <br />I Flame r e=dant coveraPs <br />[ ] Her...ig prorec=cn <br />[ ] T yvek <br />(] Respiraror, Acle: APR or SC3A <br />A/P C1._dge: <br />C] Saiery vest <br />( ] Two-way cor..^tMicarioe <br />PAR: IV <br />PLAN APPROVAJ- <br />k� <br />?lar?repared byJ Dace:(10/ ` l <br />?lar ?proved by:_ Dare: <br />