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S-H23081C2/7/921, <br />IZ.A Ni SOAQULN COU -11 ?l :�t�O-N-EN-IAL =- AL7 DIVISION <br />=L = rte' ALT11 Az\1D SAFE -1 Y PLAN <br />? T I <br />PART Ir <br />CES =z INFORMA=ON <br />EVALUATION OF POT;.NMAL F-AZARDS <br />_. Site dame: . . L abh'c, lJorts,I. <br />Caemicais ra=--ds <br />Address: <br />arc:nogers: �, <br />Contain P _'son: Pioae 'io. <br />[ j Corrosives: <br />Sweeps Numbe_n- L <br />Dusrs: .� <br />Proposed Date of investgazor./iaspecton: <br />= fosi a <br />2. Desc::ipdon and 'brief Rar:u^ve of Lsaec 4on ac:i z . <br />(1 iaorganic Gases: <br />ew UST L-smilation [ j UAFL Inves-igazion <br />: <br />[ I Tank C:osu= e L . Place [ j Tank/Pipe Repair <br />[ j O:ddiz=-s: <br />i ar-k/Pipe Removai (j R----=vat:oa <br />(J frSmIlarion of 3or___as/Monitortag Weals <br />PART M <br />3. Speccc Site Lmfor_.arion: j / <br />RrQQTjT P=—RSONAL FROTECILIVE <br />r_k No. '7z --,c Cap aC--y ?r / <br />EqurpNmrl <br />'ank Caare--= to I/ I— <br />'rrie-: <br />t I e --: <br />1. -Monitor--, _quipme= (none: Moniror-ing <br />;r g end :n s: be used or all opemdoms <br />=. Tyne or Ope^atot::,Mess <br />approprate:..rioaafe or �c--ons are <br />provided) <br />S. Le -lease i .:story <br />Combus-�le Gu/Oapg�^_ ylere_� <br />,iidence of ?eaks/soft corm--t;"zdoz:: :7. (j NO <br />(j Deremor Tribes (Soe^�) <br />Doc: mom` red G oundware con: �==ar-on: f j -MS [ 1 NO <br />(1 Photoio *•- - or- Deter <br />3ack,gound and des=t on of arty previ us '^7e3zgar:o= <br />( I Organic Vapor ?=&7: <br />or Acid ^ce. <br />( I Omer, spec*y: <br />Lf x onitor�mg rr `sera are :roc used, <br />led <br />—oaaie or acsvrl /area :•esu:e=ons:.,,_, <br />5. Pocenriai r_ealtr and Safery <br />Physical Coact^.5: (c^evk all :tar w iy $c desC_De) <br />[ J ::eat or Coid St -less: I 2= ie --r t==.) <br />-54'\ioise Sox:r:e_: " <br />Oxygen Derive=cy: <br />2 Personal P-ote--;v'e .^uipme= <br />l~we? o= ?-ore�-*_:on: [ IA [ IB [ IG` <br />j <br />= varioa: (ails, a--ps z,=inv cave-ins) <br />'wand 'mat <br />[ I Handling and Transfer of a :Iaz rdous Substaac_:Safety <br />giasses/goggi� <br />(f -e, esaiosions, erc.) Q �� <br />Steel coed/shark s�oes or boos <br />[ I Confined Space en- T. expiosiors) <br />(J ::ante retardant cove. -ails <br />Heavy equipment (pixymcml injury -a=a resaimag <br />:e=r=g protec:ion <br />r-om moving -- u ipm=r) <br />[ I Tek <br />(j R wpiramr, cTde: APR or SCBA <br />(J Odier, specify <br />A/P cai--dge: <br />(j Safe=y vest <br />7. Anticpared 3ioiogimf'c :aL r^s:UA <br />><"Lwo-way cot :.*- uniczzioa <br />[ J Snakes [ I Irsec= (j Roden [ j Poisonous Plana <br />[ I Ocher/Unknown (specry): <br />PART V <br />PLAN APPROVAL <br />0 <br />S. Narradve (provide ail infon_:.ation wbics could immaG realty <br />Dare: <br />and Sare7j, e ;-, owe_- tress, �-•_�*y of c �, :e• -3i^., erc): <br />- <br />pla_^. ?reuared by-_ r <br />� 1 <br />Plart 1nDiQVeC Oy: Da• <br />S-H23081C2/7/921, <br />