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SITE HEALTH AND SAFETY PLAN DRAFT <br /> I. GENERAL SITE INFORMATION <br /> Site Name Tosco Former Unocal Service Station ##4409 <br /> Site Address 1502 North E1 Dorado Stockton <br /> Contact Person Mark Capps Phone -(916) 928-3300 <br /> Site I D Number 911-011 1 A Proposed Date(s) of Site Work Pending <br /> II. DESCRIPTION OF INSPECTION ACTIVITY <br /> PuLpose of Activily Type of Site <br /> ❑ Monitoring/extraction well installation ® Retail gas station/former gas station <br /> ❑ Vapor extraction well installation ❑ Petroleum Plant <br /> ❑ Well abandonment ❑ Industrial <br /> ® Soil bonng/geoprobe/hydropunch ❑ Landfill <br /> ❑ Other (specify) Shallow Excavation ❑ Other(specify) <br /> Provide a brief description of the proposed activities <br /> Install three geoprobe bonngs using CPT drilling equipment <br /> Investigation-derived material disposal <br /> Soil <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 /> ZFalls, trips, slipping E] Electrical hazards <br /> Traffic control <br /> Overhead hazards ❑ Other (specify) <br /> 11SACRFPIICOMMONIrancfpllProjects\Projects1911\0111IA101421SSP2 doc <br />