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-� DRAFT <br /> SITE HEALTH AND SAFETY PLAN <br /> _ I <br /> I. GENERAL SITE INFORMATION <br /> I � <br /> Site Name: Tosco Former Unocal Service Station #4409 <br /> Site Address: 1502 North El Dorado Stockton <br /> Contact Person: Mark C40s Phone: __(916) 858 2350 <br /> r Site I.D. Number: 920-011.1A Proposed Date(s) of Site Work: Unknown <br /> i II. DESCRIPTION OF INSPECTION ACTIVITY <br /> f <br /> Purpose of Activity: Type of Site: r <br /> ® Monitoring/extraction well installation ® Retail gas station/former gas station <br /> + ❑ Vapor extraction well installation ❑ Petroleum Plant 1 <br /> a ❑ 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 /> Install one soil boring and five groundwater monitoring wells using hollow-stem auger drilling <br /> equipment. <br /> t <br /> Investigation-derived material disposal: <br /> Soil: stock filed { <br /> Water: drums f <br />+ Other: <br />+ <br />{ III. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> k` <br /> Anticipated physical hazards. Check all that apply. <br /> ❑ Heat (high ambient temperature) ® Heavy equipment <br /> f ❑ Cold ® Physical injury/trauma resulting from <br /> ® Noise moving machinery <br /> i ❑ Oxygen depletion/asphyxiation <br /> ❑ Excavation cave-ins ® General construction physical injury/trauma <br /> ® Falls, trips, slipping ® Electrical hazards <br /> i <br /> Traffic control <br /> ® Overhead hazards ,. ❑ Other: (specify) <br /> C <br /> 911-011.1A/0102/SSP <br />