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Page 1 <br /> SITE HEALTH AND SAFETY PLAN <br /> Hultgren—Tillis Engineers (H—TE) <br /> I. GENERAL SITE INFORMATION <br /> Site Name: Staten Island (APN 069-02-019) <br /> Site Address: Staten Island Road Staten Island CA <br /> Contact Person: Charlene Truong; Phone: 626-463-3083 /925-685-6300 <br /> Site Identification Number: 905.02 Proposed Date(s) of Site Work: March 18 to 20, 2019 <br /> II. DESCRIPTION OF ACTIVITY <br /> Purpose of Activity: Type of Site <br /> ❑ Geotechnical Soil Borings ❑ Industrial <br /> ❑ Gas extraction well installation ❑ Gas station <br /> ❑ Agricultural well installation ® Other(specify): Levee <br /> ® Other(specify): CPTs <br /> Provide a brief description of the proposed activities: <br /> Drill 15 CPTs to approximately 50 feet deep, collect soil samples, backfill CPTs with cement <br /> grout. <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 /> Fall hazard—physical injury from falling into an excavation>4' <br /> Unshored excavation—physical injury from collapse of sidewalls in an occupied shallow trench <3' <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 /> Uneven, muddy, terrain <br /> HAZARD EVALUATION <br /> Parameter TLV (ppm) IDLH (ppm) LEL (%) skin eyes Health <br /> NA NA NA NA NA <br />