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SAV JOA QULN COL-.N=. E_NV R0 _vEN- Ea1, Dry-ISiON <br /> SIT� 1~�a I-r:4 4ND SALTY PLA,,- <br /> PART <br /> L,a,iPAR: i P?,RT II <br /> SAL Si'Tr. W ORMA=- ON FVALUA=ON OF POT INME AL F'-AZ.ARDS <br /> _. Site ala re: I. Che-tcals razpuTds <br /> Add-less: <br /> Coma=Pe=on: .._o No. (j Caroszves" <br /> Sweeps -Mabe_-- Du=: <br /> Proposed Date of rvestgarion/bamec• on: ( j �Iosives: <br /> (I nam les: <br /> 2. Deseipeoa and brier na=t.*ve of ft=ec=on ac^vity: C I Faorgpdmic Cases- <br /> [ j New UST Imsmilarion [] UA_R lisvergation [j me-is: <br /> ( 1 Tank C:os se r Place ( ] Tank/Pipe Repair C I pa . -rs: <br /> :ank/Pipe R—oval PC3,s: <br /> [ j Installation or 3or^np/Moaizorng Wells <br /> P ART 7 <br /> 3. Soe�-;i;c Site [ *o._.az?o=: RSQTj= PE SONAL PROT'C=_ <br /> _mak Vo. , Tank C_pacLy: FQ a �y-1 <br /> Tanti Co=e---rs: Tnk?,e_- <br /> Ct!Ie_': :. -Monitor,- `ouipaenc (note: Mo '*Lori+g <br /> r <br /> ===e—mrs au:st be used for a.il ooerzenors <br /> Type of Operatics c u:niess appropriate mdonaie or_est-;cors are <br /> pro 'de-D <br /> 3. Release �-storj abuseble Gas/Ox ge-__ Mete-- <br /> ,7idence or le_ks/soil carom-nadon: C I -rz S C I NO [ j Derec_or Tuibes (Spec f•/) <br /> Doc—e=t_d G ot=dware_r cor..�.ainarion: C j ';S ( j NO [ ] ?hotoiorli"tion Decec--or <br /> Background and desa-rp on of any previous rvesmgazion [I Cr;maid Vapor s 2iyze_r <br /> or incde_ce: ( ] Otaer, specry: <br /> + aT�OtSILOaig in a_ =Arlt$ are zmr.sea, <br /> rztio=. e or acrviLr/arPez res�,c_ors: <br /> 5. Poce_n-tal Dealt::. and Safe^/ <br /> ?bysical Ca ^ : (c'e-._'r ail War appiy & des=-be) <br /> 41 wear o Coi Stress: OF thigh aabi—reap-) <br /> Noise Sourrce: b 2. Personal Proce-_-ve .^u:iptaer* <br /> ( ] Coygen Deuce::% Level of Prore-on: C]A C I3 C IC <br /> _:cavaeon: (fa-Is, ps ,SiiDpinv cave-ins) ( I ::and 'hat <br /> C I <br /> Handling and T.-ans:er of a Hazardous Subs=ce: [ j Safety giz;ses/;n Q es <br /> , -e, espiosiots, erc.) [ I Steel coed/shanft shoes or boos <br /> C I Confined Space end: (espiosions) ( I ^ame reardant cove_-all.s <br /> =envy eauipaert (physical injury& -_anima resuiring C ] Hear-ing prorec-=on <br /> =oa aov*:ng eecuir e^.t) _ (j Tyzre <br /> ( ] Respirator, circle: A.PR or SC3A <br /> [ I Other, specify A/P .�:d;e• <br /> CI Safery vest <br /> i. Anticipated 3ioiogicrl r' -ds: C j Two-way coaWLniction <br /> C I Snakes [ I L^secrs ( ] Rodents [ I Poisonous Pians <br /> C ] Oc er/Unkaiown (specify): PART N <br /> PI-AN APPROVAL <br /> 8. Narr=ative (provide ail infor-._.ation whicH could mace Heaita, <br /> and Safe_ry, Q., oowe_- fres, irate • "C_'Kes, r.' min, tse): Pian Prepare_ 5y. a? Date `® <br /> pray approved by. Dat_: <br /> %�08: (2/7/92) <br />