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SITE HEALTH AND SAFETY PLAN <br /> Compl <br /> he <br /> If a different Site Safety Plan is submitted, that lPlan must owing information. <br /> ed the following information: <br /> NAM <br /> GENERAL SITE INFORMATION <br /> ': <br /> SI q <br /> A V�j SOO t✓ �e:v [ lod(��1 <br /> !may D1L. <br /> U A <br /> y A � <br /> DESCRIPTION OF INSPECTION ACTIVITY <br /> Purpose_ o_ f�ivih, <br /> Tvu--Eff Site <br /> ❑ Monitoring well installation <br /> ❑ Gas extraction well installation ❑ Industrial <br /> ❑ Cry Station <br /> ❑ Domestic well installation <br /> ❑ Agricultural well installation ❑ Landfill <br /> YX Other(specify) Geopro6e Other(specify) G ry S,2�, <br /> Provide a brief description of the proposed activities: Aflv WI C.6 /Vile Z�, <br /> 6QAn ritj (o BG$ t IGiln p D recT p f(� I t <br /> Investigation derived material disposal: Soil Water Other <br /> POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Anticipated physical hazards,Check all that apply: <br /> V Heat(high ambient temperature I( Heavy Equipment <br /> ❑ Cold 2 Physical injury/trauma(resulting from moving machinery) <br /> Iff Noise W General construction <br /> ❑ Oxygen depletion ❑ Physical injury and trauma <br /> ❑ Asphyxiation ❑ Electrical hazards <br /> ❑ Excavation id Other(specify) 7t2nF:;:tc_ <br /> ❑ Cave-ins <br /> 2 Falls, trips, slipping <br />