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l <br /> SITE HEALTH AND SAFETY PLAN <br /> I. GENERAL SITE INFORMATION <br /> s <br /> I <br /> 'r Site Name: Tosco Former Unocal Service Station #4409 <br /> Site Address: 1502 North El Dorado Stockton <br /> Contact Person: Michael Mitchener Phone: 916 858 2350 <br /> 1 <br /> Site I.D. Number: 920-011.1A Proposed Date(s) of Site Work: 5199 <br /> II. DESCRIPTION OF INSPECTION ACTIVITY <br /> Purpose of Activity: 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 boring/geoprobe/hydropunch ❑ Landfill <br /> ® Other: (specify) Shallow Excavation ❑ Other(specify): <br /> _ Provide a brief description of the proposed activities: <br /> Underground storage tank replacement <br /> Investigation-derived material disposal: <br /> Soil: stockpiled <br /> Water: <br /> Other: <br /> III. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Anticipated physical hazards. Check all that apply. <br /> E <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 /> ® <br /> Traffic control <br /> ® Overhead hazards ❑ Other: (specify) <br /> 10HAZARD 4EVALUATr <br /> �7 SSP 911-011.1A <br />