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IO.A.QT.MK COUNT --,r EYVI-RO-NMEN-MAL =- ALTH- DI-Y-M-LON <br />ST L= I-MALTH -,�.N.47D SAFFEETLY Pl-k'.q <br />a AA <br />G- AL Ss —LZ �OFMAMCN <br />Slre.Maxae: Oul <br />Address: <br />Contac Pe=on: PhoaeLqo. <br />Sweeps Number: <br />Proposed Date of invest .-amor./immecton: <br />2. Desczioldon and brief ==m&e of kwoe--,4on ac:'7irr. <br />"66'4ew UST Insmilamon U'AR Luvesdgmd= <br />"I 1 -Tank C:osu--. in Place TankP. -.ve R=air <br />XTank/Pipe. Removal RA--=CZVzdoa <br />of Bor,�--s/Mor:koring Wells <br />3. <br />Soet"Fc Site L--v:or:=arion: /? <br />ank .40. 7ank Cavacirr. <br />-ark Conren-ts. <br />Hype of 0-pe-n-rior.: <br />Reiease Hisrorjr <br />W,ridence of lealWsoil )-rzs (I NO <br />Doc-=enre-d G-roundwar-w ajazzzaination: E I -rES NO <br />6. Pocen-dal i"iii1th and SaE---,r <br />Physic --I Coact-rms: Cche,-k aa :har zvviy & des= -;*be) <br />or Coid SL ---e=- °F ('riga ambient m=.) <br />Noise Source: 12g.!C <br />Oxygen Dleddency- I <br />':- vamon.: (EOs, alas ziippingg, cue -ins) <br />Hand Transfer F - - �absr;mcz-- <br />ling and Or Z :322VICUS <br />(ffnx' expiosions, <br />C Condned Space en --r-. Ce.. iosions) <br />Heavy equxp=e= (phyricai imJL' T & =m=za resmiting- <br />:o==ovin-eqmprme--.1, ha�c6�-Id' <br />Odler, sped y <br />7. anticipated Bioiog-,*=' NO RJ e - <br />C j Snakes T=se--= C ] Roder Poisonous Plants <br />C Other/Unimown (speci:ry): - <br />S. Narrative (provide all :-.Zor---a=on waits couid imzoacz <br />and Safe -7 e.g., power Les, 7 or d=es, -.e=ZLM, e--,. <br />P Ag, <br />1,H2308i (Z/7/92) <br />PARTE Ir <br />EVALZA-ZON OF PCT IIA F-A2ARDS <br />P.AR:7 M <br />:LCQU -Cl <br />MM P=�SCN_AL P&C= 74E <br />:-QUIPNIEN-1 <br />Monitoring Squipramm Chore: Mord.tor-ia- <br />=usz be used for ail operations <br />a-cless apprnpriam mdonaie or resaic--onz are <br />KC110dMIUS-6ble Gas/Ox7gen Mieter <br />Dete=or Tubes (Speci�) <br />Phoroioni-zm'ort Deter <br />i Or -.=c Vapor Ama7zer <br />I Other, spec-ify- <br />rf =ni =*g =*.s-,=- a= are =or used, <br />--214 -..6 <br />Ms <br />-onaie or ac:iv-L7 /Zral - <br />2. P----sonai Prorec=7e z;un=e--- <br />Larml of Proce--lion: C ]A [ JB C IC AD <br />mar <br />Safe -7 Zia=es/T.0%Zies <br />pf,.Smei coeds: anis saxes or boors <br />( 1 Flarme retardant coveralls <br />'XHe2r=g VrOcec�"* <br />Respirator, Ocie: APR.. or SCBA <br />.A/T car�---d- ------------- <br />Safe -_7 TleSi` <br />Two-way co=--"-,=Czdor- <br />PA.FC-7 -.v <br />PLAW APPROVAL LP <br />W by. 7\ <br />Dare: <br />?!an.4muraved byC�� Dare- <br />