Laserfiche WebLink
t <br /> SAiy' IOAQtIIN COTJ7-1 Y E-4-VM0?-'qI EN-rAI. �:E.�LT-11 DIVISION <br /> SITE F-F-ALTH .AIND SAFETY PIAN <br /> ?ART I °ART II <br /> GENERAL Shit. INFORMA=ON EVALUATION OF POTMi'IZALZ MAZARDS <br /> _. Site Name: 1 ¢` 1. Chemicals "riazards <br /> Address: ! S i l [I Carcinogens: <br /> Contac:Person: Phone No. (I Catrozivess: <br /> Sweeps -Ntumoe--n 1 ' z [ I Dom: <br /> Proposed Date of=7esagmon/! soection: riosives: <br /> 1amm�bjeg; <br /> 2. DesciDdon and 'brief IIat adze of inspection, ac^viry: ( Laorganic Cases: <br /> ( ] New UST instafladon [ j (TAR.investigation Metals: <br /> ( Tank Cosur- in ?Lac_ (] Tank/Pipe Repair [I Omidiz=*s: <br /> Tan. <br /> �c!?ipe Removal [I Re—scvatioa [I?Ci°r_ <br /> ] installation of 3orings/Moniror ng Wells <br /> ?ART DI <br /> 3. Scecidc Site ln_*or—ado= REQU= PE:RSONAZ PROTE{.TIVE <br /> Talk No. > Talk Capacity: 101e-C EQUPME:Vi' <br /> ?'ark Contents: jLP Tank Age: <br /> Ot:2e_r: 1. Monitor*mg Eauipmenc (note: Vanitarting <br /> ns�=nears =nus—,be ued 'or aLl opesadons <br /> =. Type of Operation: unless appropriate:aconale or_est actions are <br /> orovided) <br /> S. Release dstory- Combuszmi Gas/Oxygen Merer <br /> S,ridence of leafs/soil canmza nar.`an: [ j 'Ms [I NO [ ] Derecor Tribes (Specify) <br /> Doc-mnenred Groundwater con a=;nadon: C I `S [ I NO [ ] ?bocoionizrdon Dececor <br /> 3acc,round and des=pilon of any previous i=7esdgadon [I Or;amc Vapor inaiyzc <br /> or incidence: ( ,T Ottier, specify: <br /> LE u aniror g i===e^ss are :got::sed, <br /> mmorale or activir//area :wt::ctons: <br /> O. Pocennal realty and Safe_q <br /> Physical Cance..--s: (chedc ail t.=apply& descne) <br /> ( ] -ear or Cold Stress: 0 Cnigh ambient temp.) <br /> ( : Oise Source: 2 P_=onal Procure Equipment <br /> ( CmIgen Deddency: Level of?tote oII: [IA [IB W D <br /> :"cavaL'on: (fails, S_ps ,Slipping, cave-{IIS) Hard har <br /> C-1 Handling and Tzansfer of a Hazardous Subsmnce: Sar--y glasses/goggies <br /> Core, espiosions, etc.) Slee' coed/sbank shoes or boots <br /> ( I Conned Space entry: (espiosions) I :.ane rerardant coveralls <br /> -eavy equipment (physical injury& aauma ting -eaniiig protection <br /> .=am moving e?uipnert) , G Ty<rek <br /> Respirator, cirde: or SC3A <br /> ( I Orhe_r, specify h/P c-..,.�;d,e: - <br /> [I Sarey vest <br /> i. Aadcipaced 3iolosg:c..l "razzrrrds: [ I Two-way communimdor- <br /> ( ] Snakes [ I insects ( I Rode=nts [ I Poisonous Plants <br /> ( ] Other/Unimocvn (specify): PART IV <br /> PL2.N APPROVAL <br /> 3. Nar adve (provide ail inrormadon wbic i could impar Health <br /> and Sates/, e.-, power Lutes, inre�/of daces, :e*roia, etc.): Pia^. Prepare_ by: Date: Zf/a <br /> pry, anomvee by Dat_: <br /> E_='?3081 (2/7/92) <br />