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0 <br /> SITE HEALTH AND SAFETY PLAN <br /> I. GENERAL SITE INFORMATION CRAFT <br /> Site Name Don Rogers Transmission Shop <br /> Site Address 515 West Charter Way, Stockton <br /> Contact Person Kathleen Waldo Phone 916 565-4370 <br /> Site I D Number 880-039 1A Proposed Date(s) of Site Work <br />' II. DESCRIPTION OF INSPECTION ACTIVITY <br /> Purpose of Activity Type of Site <br /> ® Monitortnglextraction well installation ❑ Retail gas station/former gas station <br /> ❑ Vapor extraction well installation ❑ Petroleum Plant <br /> a ❑ Well abandonment ❑ Industrial <br /> ❑ Soil bonng/geoprobe/hydropunch ❑ Landfill <br />' ❑ Other (specify) Shallow Excavation ® Other (specify) transmission shop <br /> Provide a brief descriRtion of the proposed activities <br /> Completion of two groundwater monitoring wells <br /> Investigation-derived material disposal <br /> Soil drums <br /> Water drums <br /> Other <br /> III. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Anticipated physical hazards Check all that apply <br /> ® Heat (high ambient temperature) ® Heavy equipment <br /> ❑ Cold ® Physical injury/trauma resulting from <br /> ® Noise moving machinery <br /> ❑ Oxygen depletion/asphyxiation <br /> ❑ Excavation cave-ins ® General construction physical injury/trauma <br /> ® Falls, trips, slipping ❑ Electrical hazards <br /> ® Traffic control <br /> ' ® Overhead hazards ❑ Other (specify) <br /> ' N lrancfpl\Projects\Projects1880103911A\HSP doc <br />