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EXCAVATION PERMI SIMPLOT- LATHROP Section j-Job Description Location of excavation: West Well(BSW) Estimated depth of ❑>6 inches to 4 feet excavation: >4 feet — --- - - Reason for excavating: Install a series of wells —� Work activity description Well drilling Nature of work to be Hydro excavate to a depth of 6', drill rig from that depth. undertaken and method of excavating: Group Performing the Excavation Work: Person Responsible: ❑ Simplot Personnel Contractor. �-x - -G c�ns+s FOS N7F,C Section 2-Hazard Assessment Document the hazards and analyse the risks associated with the excavation or digging activities to be undertaken. Underground Services Identification Type of Interview of knowledgeable sources on possible utilities in the area underground Visual inspection and search of the work area and potential utilities in the area piping and Review of existing utility maps or drawings utility identification: Underground service location and depth detection undertaken/to be undertaken Identification to be completed by: Date: Have utilities Yes '— Complete this Section been Utilities have been identified that could impacton the excavation tasks. u w +w.. identified? ❑ No Proceed to Collapse& There are no utilities in the area/vicinity that could impact on the excavation tasks. Entry Controls Section Utility or piping type Proximity of piping or utilities Depth details: Identify the type of service(s) present: water, stormwater, sewage, process (check appropriate):ate): (as detected or pipeline or services, imgation lines. control wiring, gas or fuel tankJpipeline, Service directly where Service in proximity of best estimate) telecommunications,live/unknown electrical,non live electrical,etc: excavation required required excavation 1.1/��h�wr- /�rKd�;GS ❑ ❑ ❑ Where a service has been identified,insert information in the service location and restrictions sections below to ensure a safe method of work Utility location(s)(Provide details/description of locations as detected,or an explanation of areas shown by marking paint or similar): Restrictions and procedures to be followed to ensure safe work conditions(Provide details/description of work restrictions required): try d.-o /6,,& iCy�lt�.r.l Additional Considerations_ Check as 4:�- Exclusion/barricading is to be erected to exclude access/prevent falls appropriate ❑ Controls will be required to limit operating areas of earthmoving equipment ❑ Controls are required to prevent undermining of near-by structures ❑ The area is likely to contain contaminated soil/old process materials/chemicals ❑ Hazardous material present could make the excavation atmosphere unsafe for entry C! New pipelines or services will need to be marked/identified&/or drawings updated Version 3—Page 1 of 2 6-19.2018