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................. <br />;I A413 Nov a* W4111 1Z I DIM3 a we U W -1111Z <br />PART <br />PART II <br />GENERAL SITE INFORMATION <br />EVALUATION OF POTENTIAL HAZARDS <br />1. Site Name: Fr a n IL S m ^ <br />1. Chemicals Hazards <br />Address: -7 0.7 7 osr — .' C_ <br />Carcinogens: <br />Contact Person: 6" k.0 -n Phone No. <br />Corrosives: <br />Sweeps Number: 14 Z� <br />Dusts: <br />Proposed Date of investigation/inspection: M ,%4 <br />V osives: <br />E.I <br />H-Flarnmables: <br />2. Description and brief narrative of inspection activity. <br />[ ] Ingrganic Gases: <br />] New UST Installation UAR Investigation <br />LJ -Metals: <br />]3x* Closure in Place Tank/Pipe Repair <br />Oxidizers: <br />PT Tank/Pipe Removal Re -excavation <br />PCB's: <br />Installation of Borings/Monitoring Wells <br />PART III <br />3. Specific Site Information: <br />REQUIRED PERSONAL PROTECTIVE <br />Tank No. i 'JI& - *"- '0 Tank Capacity- <br />EQUIPMENT <br />Tank Contents: W e. sr -r_ c, Tank Age: U <br />Other: <br />1. Monitoring Equipment: (note: Monitoring <br />instnunents must be used for all operations <br />instruments <br />nn <br />4. Type of Operation: 5-C or 0 Ice- <br />unless appropriate rationale or restrictions are <br />provided) <br />S. Release History- <br />[ ] Combustible Gas/Oxygen Meter <br />Evidence of leaks/soil contamination: YES NO <br />[ ] De for Tubes (Specify) <br />Documented Groundwater contamination: YES [,TIITO- <br />[,JPhotoionization Detector <br />Background and description of any previous investigation <br />I Organic Vapor Analyzer <br />or incidence: <br />I Other, specify - <br />If monitoring instruments are not used, <br />rationale or activity /area restrictions: <br />6. Potential Health and Safety <br />Physical Concerns: (check all that apply & describe) <br />Heat or Cold Stress: OF (high ambient temp.) <br />Noise Source: <br />2. Personal Protective Equipment <br />[]0 n Deficiency- <br />Level of Protection: [ ]A [ ]B [ ]C +JV' <br />[4'fxcavation: (falls, trips slipping, cave-ins) <br />kTIla-rd hat <br />Handling and Transfer of a Hazardous Substance:glasses/goggles <br />�Stetoed/shank <br />(fire, explosions, etc.) <br />shoes or boots <br />Confined Space entry- (explosions) <br />Flame retardant coveralls <br />LJ,Ke'avy equipment (physical injury & trauma resulting <br />Hearing protection <br />from moving equipment) <br />Tyvek <br />Respirator, circle: APR or SCRA <br />Other, specify <br />A/P cartridge: <br />Safety vest <br />7. Anticipated Biological Hazards: <br />Two-way communication <br />Snakes [ ] Insects [ ] Rodents Poisonous Plants <br />Other/Unknown (specify): <br />PART IV <br />PLAN APPROVAL <br />8. Narrative (provide all information which could impact Health <br />dikes, <br />Plan Prepared by: 4r�Date: 3-:07Y4-3 <br />and Safety, e.g., power lines, integrity of terrain, etc.): <br />Plan Approved by. Date: <br />EH23081 (2/7/92) <br />