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TOAQLIN COL?V i Y jr:V7/MO?.NLi_=N7t A !-,AL,TH DIVISION <br /> SIT= 1-MAL.TH .-k2,TD SAF=i Y Pi—A.Y. <br /> ?ART Z ?.ART II <br /> (MNU AL SM URFOR'LiAMON EVAL=ON OF POTEN- AL F-AL.ARDS <br /> .. Site Name: .gyp 1. Chemicals Hazards <br /> Address: G/v® fCl C j Carciaog—: <br /> Contac_Ptnon: a✓ �w4— Phone No. give Carrosives: <br /> Sweeps NumberPict [j Dusts: <br /> Proposed Dare of=7e3M% onAt=ec on: plosives: <br /> `{' gla=ables: <br /> 2. Desc Ddoa and 'brief aar arive of lase_mon ac^vitf. ( j tnorg=*c Cases: <br /> C j New UST trstadarioa [ j UAR lavesagarion [j Memis: <br /> C I Tank Closure in Place [ j Tank/Pipe Repair [j Czidize_*s: <br /> C Tank/Pipe Reinovai [ j :fie-scavaran [j PC3'3: <br /> [ j anon or Bor�ags/Moniroring Weils <br /> PART M <br /> 3. S6ecit3c Sire tnfotmadoa: REQ]U= P1_PRSCDT.AL PRO-T=C= <br /> T:rLk Vo. t-27 Tank Capadty. ,P l:n EQUIP&1 , , <br /> T ar_k Contents: ,,@_� G-/L Tank Age: <br /> ,timer: 1. Monitoring Eauipraet r: (note: Moniroring <br /> �ns.r- erts must oe usedor ail opemdons <br /> Type of Cae_raticn: 5 ,e•,r� �:riess aparoorare mdonaie or=es=-c;aas are <br /> provided) <br /> 5. Releaseisror-/- buseble Gas/Oxygen Mere_r <br /> c,7ide_nce of leaps/sail con*aminadoa: Derec=r Tabes r,Sae�f- <br /> /) <br /> Docs * erred Groundwater conmmiradon: j ':''cS [ j NO [ j Phoroioniz=t ot: De=_ecmr <br /> 3ackgTound and desaipdon of any Previous =-restigar on [j CrT=*c Vapor S.aaiyzer <br /> or inddence: C j CtdheY sped&/: <br /> If z onirormg it `=errs are nor:sea, <br /> adonaie or ac=Mmr/area res—;C—tors: <br /> 5. ?ocendai :eaiu and Saie_y <br /> ?!:ysicai Cance-_s: (cder?r ail ch=apDiy& descae) <br /> [ j fear or Cold Stress: 'IF (nigh arreie=remD.) <br /> (4�Noise Source: 4nEAE dE ZCA 2. Personal ?rore_ve Eauipme= <br /> Cr 1 oxygen Cedcienc/: Leave-' or Prore moa: C IA C IB f- <br /> C"1` -cavadon: (fails, a-ias ii in, cave-dins) rAvzv :nand oar <br /> C I Hand; and Transfer of a Hazardous Substance.• afey Biasses/-_,o es <br /> (fire, explosions, arc.) C�CSteed coed/shank shoes or boors <br /> C I Condnea Space en=r. (exniosions) C j R=e retardant cove'ails <br /> {-f�eavy e=praerr (phymc3i sjury& "-att3Ta resuinng rearag ororec^on <br /> mom :coving equipment) sE� j'g Tgve <br /> C Respirator, cirde: or SC3A <br /> [ j Orhe-, sped_'Y aJP car .:d- Cd!Z_ <br /> o- <br /> C I Sare*y vwr <br /> 7. ?.nddpared 3iolog c_i ciazWrdz: [ j Two-way co uni don <br /> f j Snakes [ 1 insects [ j Rodents [j Poisonous Plants <br /> ( j Ot e_r/Uniciown (specify): PART N <br /> PLAW APPROVAL <br /> 3. Narrative (provide all information which could i3=ac'Health <br /> and Sarer</, e.;., power L*nes, iatelr�rT of dilkes, =-_-zia, etc): ?tar Prepared by- 'irl-r— Dare: <br /> Ran Axoroved by. Dare: <br /> ='?3081 (2/7/92) <br />