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a.►' ��arr <br /> SITE HEALTH AND SAFETY PLAN (HASP) <br /> Prepared by: Date: /n1 rt' I 1 ; I motel <br /> W.O. Number: //-!5-/ <br /> Project Identification: Site History: (describe briefly) <br /> Division: J5- c—C�.Ci 11C)rt 1/l/��-S-� <br /> Department/Office: A/C, rL►VtG?LrG� t✓'�t, j�l�f�_ BT�x <br /> Site Name: S+o r e it-711 <br /> '�, <br /> Client: Pe go vs C C 1'eC%l ir7 -totn k. ex en vcc'f-;or� <br /> Work Location Address: <br /> 4f S7 LL,'&-5.+ L�>, <br /> S+0C k+n CA <br /> Scope of Work: (describe briefly) <br /> 1 le e�- so i t ��� �ro a ne1/e�ua�ct�►-- �'cr mac► t�� -E'r-a�,1 �,• <br /> PLIS � (C eo p -Obe-) Sctr►z 1 hoc_c%c-�- �r�S. <br /> "' ❑Site visit only; site HASP not necessary. List personnel here and sign off below: <br /> I <br /> .r Regulatory Status: <br /> e regulatory status: eased on the Hazard Assessment and Regulatory Status•determine the standard <br /> aocticaole to this protect. Indicate below which standard MASP will t>c used and append f+e <br /> [�ERCLA/SARA RCRA Other Federal Agency appropriate pages of this form along with the standard Plan. <br /> US EPA ❑US EPA ❑DOE <br /> State ❑State ❑USATHAMA ❑Stack TestNPL Site ❑Air Force ❑Air Emissions <br /> HA NRC1910 ❑10 CFR 20 ❑Asbestos1926 ❑Industrial Hygiene State y �i1 L'/r"O/�mC��l��t� ❑ ❑ <br /> Review and Approval Documentation: <br /> Reviewed by: <br /> a. P.M. G � � SL Date: <br /> b. P.D. Date: <br /> c. 0 6,IRSO Date: <br /> d. SHSC <br /> Date: <br /> IAoproved by: Date: <br /> ❑Corporate Health and Safety Director(CHSD) <br /> ❑DSO/RSO (Only with specific delegation by CHSD) <br /> �j Project start date: �'/I/Tactivibies <br /> e HASP must be Amendment date(s): <br /> End date: By. <br /> Z/3 i /9� d/reapproved for any 1. <br /> / conducted after: Dare 2. <br /> 16 - 3. <br /> a. <br /> 5. <br /> 2— <br />