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SAN .TOAQLl i COL--Ni77 ~VSO? -NMN-71 ��, P.. -.ALT' ` Dr-=LON <br />SI'F� r�AL.TH AND SAFETY PI -A -N <br />?ART I 'ART II <br />G'=±E SI= INFORMAinON EVALT ON OF PO= AL r-rAZARDS <br />_. Site Name: <br />L Che=licais �:az2rds <br />Address: <br />[ 1 Cacnoges <br />Conrac_ Person: Phone No. <br />[ j Corrosives: <br />Sweeps Number- <br />[ I Dusm <br />Proposed Dare or investigat onA spec on: <br />(j plosives: <br />f I ?ammanj�- <br />2. Descipeon and brier aarz=ive of inspewon ac::iviry: <br />[ I Inorganic Cases.- <br />ases:New <br />NewUST Insg!ladon [ ] UAR Invesrdgzdon <br />[ j Memis: <br />f 1 Tank Closz--- in Face [ j Tank/Pipe Repair <br />f I Tank/Pipe Rerovai [ j le-,Seavzrion <br />[I PC3'r. <br />[ ] Installation of Bor.ngs/Moniroralg Wets <br />PART u: <br />3. Soecidc Sire imro=zdon: <br />REQUjMD PSRSONAL PRO= -C=. <br />I auk No. C.apacry: <br />EQULD T <br />Tanis Conre^_ts: Tank Agp.- <br />Criler: <br />I. Ylon rot~g anuipme= (note: Mor-irroring <br />=5.: errs �L•TL oe used for all operations <br />?. Type of CDenzziom: <br />ess a=mprate -mriom,e orres cions are <br />provided) <br />S. Release 1- stor/: <br />( I Coranusz2ble Gas/Oxygen ylere_r <br />e .ride^_ce of leaks/sau con==iz 'oh: [ j "_'�_S [ ] NO <br />[ I Der ---=r Tunes (Soec�) <br />Docrune=ed Groundwater corer :ni anon: [I ':z..S [ j NO <br />[ j Phocoio 'on D * r <br />Back,—ound and des=tion of any =mous ir°ves^ on <br />[ I Or -.a -,-,ac Vapor?._aiyzer <br />or inside--ce: <br />[ j Or..e: spec *y- <br />If -z: nra=g ='s -="-"e= are :.oc rsed, <br />.-onaie or actvity' /area :st^:c :ons: <br />5. Pocerdal Health and Safe_*y <br />Physical Cance---= (c^..e-k all :!:= zD iy & deSC:Ebel <br />[ j : iear or Coid Stress: o= (high a=ierr tarp.} <br />f I Noise Sou_x=.- <br />2 P nonai P.ore--ve Equ=enr <br />[ I men Decency: <br />Leve! or pmcecdon: [ ]A [ IH f IC [ ID <br />[ ]-acavarion: (Palls, ps ,siipping, mve-ins) <br />( I :-ad har <br />[ j Hiandling and Transfer of a r'_azzrdous Subsaace.- <br />[ I Saieey giz: ses/gogafts <br />Cd--, essatosions, etc) <br />[ I Steel med/s!:aax shoes or 000cs <br />f ] Confined Space entry: (esniosions) <br />[ j .---,=e -e covera!Ss <br />C J `�eavy e'3umme_= (Physic it !!jury & am=a <br />f I He3i: ►9 s7roteL."'OYI <br />r-om zovm equipment, <br />(1 iyvek <br />(j Respirator, crce: APR or SOBA <br />[ I Other, soe=ry <br />AP .:^age. <br />[ j Safety vest <br />7. Anticipated Biologi=i Ha=rds: <br />(j Two-way con^xmiQrion <br />f J Snakes [ I Insects ( ] Rodents [ I Poisonous Piaats <br />[ J Other/Unknown (sherry): <br />PAR= iV <br />PLAN APPROVAL <br />8. -Narrative (provide all information which could iraac Heait h <br />and Safely, e.g., power 11 --es, inre7s7 of di.+ces, eec): <br />?!a-_ Prepared by- Dare: <br />?!a --Approved by. Dare: <br />-223081 (2/7/92) <br />