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Page I <br />SITE HEALTH AND SAFETY PLAN <br />Hultgren — Tillis Engineers (H—TE) <br />GENERAL SITE INFORMATION <br />Site Name: Bacon Island (APN 129-05-026) <br />Site Address: 3201 North Bacon Island Road <br />Contact Person: Jerry Hanson 925-348-0753 <br />Site Identification Number: 212.15 Proposed Date(s) of Site Work: March 14, 2018 <br />II. DESCRIPTION OF ACTIVITY <br />Purpose of Activity: Type of Site <br />® Geotechnical Soil Borings 0 Industrial <br />❑ Gas extraction well installation ❑ Gas station <br />❑ Agricultural well installation ® Other (specify): Levee <br />❑ Other (specify): <br />Provide a brief description of the proposed activities: <br />1. H -TE engineer will mark USA with white paint for the location of each soil boring and call <br />USA. <br />2. H -TE engineer and subcontract driller, Gregg Drilling., will drill five 20 -foot soil borings and <br />collect soil samples at the locations shown on the site plan. <br />Investigation -derived material disposal: <br />Soil: soil cuttings may either be removed or spread out near the exploration holes. <br />Water and Fluids: NA <br />Other: NA <br />III. POTENTIAL HEALTH AND SAFETY HAZARDS <br />Potential Hazards include: <br />Heavy equipment - physical injury/trauma resulting from moving machinery <br />Electrical hazards - nearby overhead wires underground utilities <br />Slippery and/or Bumpy Roads <br />Falls, trips, slips <br />Mosquitoes <br />Dust <br />Noise <br />HAZARD EVALUATION <br />Parameter <br />TLV (ppm) <br />IDLH (ppm) <br />LEL (%) skin eyes <br />Health <br />NA <br />NA <br />NA <br />NA <br />NA <br />