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S h <br /> r ^ ... • <br /> Mar. 13 2000 34:41PM F2 <br /> 4 <br /> w" <br /> SITE HEALTH AND SAFETY PLAN <br /> All of the following must be completed. If a different Site Safety Plan is submit ed, that Plan must include the <br /> following information: <br /> I. GENFAUL SITE INFORMATION <br /> Site Name: <br /> Site Add",,, RAF4 <br /> Contact Person: �Ck— Sc LFr�� - ��'�tc Phone <br /> Sire ldeutt^cation `:crher - ^c;ec Cate : e `d:.:. 1AC -moi <br /> II. DESCRIPTION OF LtiSPECTlON ACTIti IT', <br /> Purpose of Acav+r: T'V7e of Six <br /> G Monitoring well installaton ladust"ai <br /> Gas extraction well Inst"'Mnon _ fdS 3rariOn <br /> �7 Domestic well installation = !a*eatt <br /> Q Agricultural well installation X ether (Spec__ 1�Prrt SP* ct <br /> 'R1 Orher (specify;• Gt `��'�-�t-tt�+tc�y�sL <br /> SO 1L Off- :L.(=G� <br /> Provide a brief description of the proposed aca• t:.es <br /> 4 *3 o NLA r-U S QP -VZ- 7:�' <br /> Investigarion-d,erj%�d marer'3l dismsal: <br /> Soil: Nle <br /> Water• N�A <br /> Other: N�p <br /> III. POTENTIAL FM At TH AND SAFET'i FIA.2ARDS <br /> Anticipated physical hazards. Check all that apply. <br /> beat thigh ambient temperature) �R Heavy equipment <br /> ❑ cold Sd physical injury!caumaresulting from mov Lag machi.er. <br /> jCR noise <br /> ❑ oxygen depletion C Generalaonsttvction <br /> ❑ asphyxiation ❑ physical injury and trauma <br /> :� electrical hazards <br /> ❑ Excavation <br /> C cave-ins = Utter specify, <br /> ❑ falls. trips, slippittg <br />