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SA V 70A Li �.iR � It/ZSiON <br /> j7 P L ANT <br /> PA-R- i ?SRT I; <br /> G=Y AL S 2q. ORMAMON F)a.LMA=ON OF POT=--N--,IAL F AZkRDS <br /> _. Sire Name: I. Ctie_^ie�.is 'r'a�zrCs <br /> Add.ss: <br /> Conee Person: CPhone No-c"2 j Ca---Msves: <br /> Sweeps N=ber. Q31 -�KDt'ss: <br /> P:-ODOsed Dare OI c :,-Icslves: <br /> (Ia--*manles: <br /> ? Des=:Ddon and •'brier of avec--;on ac='viry ( ] Lona✓;c Cases: <br /> [ ] New UST T-SMIlaton [ ] UAR Invesrgamon �Iemis: <br /> ( j Tank C105-,I'e Place (] Tarrk/Pme Repair ( ] O�diz`•s: <br /> [ ] Ta^k/pipe Ra-oval ( ] Re--=c=t:oa (] PG's: <br /> ( ] "sm!Iadon of Bar-gs/Marirar g Wens <br /> 7e < a!�Xee-,l ?ART M <br /> 3. See--?^c Site L- or=aric=- R=QTj= P=T�SCNA_L PROi=C== <br /> -a'_k Vo. an_'ti C_pacry RQULDi <br /> -mk Canre_:.rs: Tank Age <br /> Cr:e_r Mor,rOrT'g Equip;,e'?c (Lore: ylan_�Lar <br /> � m'.:sr be used for ooe_zdo= <br /> T;rpe of Cpe_-adcc `3' Q %L�i o e✓s aapropr'are zdonaie or_es=:c=ers a_e <br /> �rovidec� <br /> �. Reserse I-_srarl ( ] CombuscIle Cas/Oz*�P^ vterer. <br /> ,ride_ce of leaks/sail cane*^;r+arioc: [ ] vEs ( j NO [ 1 Derec_or Tubes ' cecrj) <br /> Doc•n>--red GroLawarer com==inamon: ( j `.'=S ( ] v0 ( ] Phoroiomi=rion De_ec:ar <br /> lacf 'bund and descPt:on of any Previous _vesd,-,adon [] Cr;zmc Van or 1raiyz--- <br /> or- iI>.cde_ce: [ j Ct:e_, s?e ry <br /> Ii =Qrdr0,--g 'Sa-re ?0r :se <br /> 2^on2.le or aC=T_r7/z--ea .s=c_ons: <br /> 5. -ealth and Safe^/ <br /> ?bysiczl Carc_r✓-: (c^e-,f ail ci:ar apoiy & dese=De) <br /> :ear or Coid Sc ess: °c (high. =bie-r resp.) <br /> Noise Source: Z Pe_r;onal Prote--:ve Equipmi- <br /> I i C.�g°c Dence_^_cj Leve! of Prpre on [ IA [ IB [ IC XD <br /> ] lcavaL'on: (_mss, =--Ds sdopin'o Qve-:ns) 1 rd Bat <br /> [ I =angling and Transfer of a i= r_rd <br /> .aous Substance: afe-y -4 ses/;o-4es <br /> (F.ree=iosio=, etc) - remit Loed/s anic szoes or booa <br /> ( ] <br /> Con,;-led Space e^--T. (espiosions) ( j 7-=e re=dant covez-aiLs <br /> ( ] -ezvv eaUID=le= (pay c- =Jury& ca=a resulting ).� e^rsag prorec::�cc <br /> 0 TL' rr0VIn(r Lpvek <br /> ( J RxspLarprI cycle: A-PR or SC3A <br /> [ i Ocher, specify A/-D <br /> `� ery vest <br /> 7. A^_dcpaced Bioiogirt ::Gt'�r:s: �11aYle_ ( J Two-way comWunimdou <br /> ( I SBakes [ I L^sec*s f ] Roden ( I Poisonous Plants <br /> [ I OChe_/Un..Imaum (specify): PART IV <br /> PL-AN APPROVAL <br /> 3. Nar:ar ve (provide a1 -*or-^radon waicz could impaa Fiea!th �p / n <br /> SafeRy, e.g., ?owes L^es, inreg*'-)r oI ares, :e_rmlr� erc.): ?laY ?re7ared byY r Dale: -3 — <br /> and <br /> P!an S.gproved by- Dare <br /> C2/7/92)j /Vo e4"Jzv 6,6, &VL secli 6 <br /> a� <br />