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Job No 9347-9013 <br /> SITE SAFETY PLAN <br /> Job Title Shell Service Station (WIC No 204-4416-0202) <br /> Job Address 420 West Kettleman Lane <br /> Lodi, CA <br /> Project Manager Steven J Osborn Home Phone <br /> Fugro Office Phone (916) 782-2110 (Roseville) <br /> Introduction <br /> The purpose of this site safety plan is to establish requirements for protecting the health and <br /> safety of site workers for the above listed project It contains safety information, instructions, <br /> and procedures <br /> Organization <br /> The following personnel are designated to carry out the stated fob functions pertaining to the <br /> site work All site personnel have read this safety plan and are familiar with its provisions <br /> Name Company Sianature Date <br /> Site Safety Officer Steven J Osborn Fugro West, Inc <br /> Project Team Leader Steven J Osborn Fugro West, Inc <br /> Field Team Leader Steven J Osborn Fugro West, Inc <br /> Field Personnel Drilling Subcontractor <br /> (print name) <br /> Work was accomplished in accordance with the site safety plan, with the following exceptions <br /> Site Safety Officer <br /> Date <br /> (RETURN ORIGINAL COPY TO JOB FILE WITH SIGNATURES) <br />