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AUG 26 '96 12 26PM HALLIBURTON/BROWN & ROOT ENVIRON P 1 <br /> Brown & Root Fnvironment.d EZ Serve Health and Safety Plan <br /> 4 0 SITE-SPECIFIC INFORMATION <br /> Official Project Tate E Serve Store ## 100878 Project # MY41 <br /> Project Start Date AUG <br /> G 9 <br /> Project Address 1012 West Yosimite Ave, Manteca, CA Phone # <br /> Project Manager Ric h Roberts Phone # (904) 730-8777 <br /> On-Site Supervisor AslNoted in Logbook Phone # <br /> Site Safety Officer As'Noted in Logbook Phone # <br /> List of Major Tasks (T=ill Cut Reverse) <br /> List of Chemicals on or tc,be Brought on Site See Ap2endix A for Hazardous Material Data Sheets <br /> Entry to be made into an Excavation or Confined Space Yes X No <br /> Name of "Competent" Pei son Colleen Dalton (954) 570-6865 <br /> Names of BRE Field Personnel TBD - As Noted in Logbook <br /> Subcontracting Companies TBD - As Noted in Logbook <br /> EMERGENCY PHONE NUMBERS <br /> Ambulance 911 Police 911 <br /> Hospital St DominicA Hospital Phone # (209) 825-3500 <br /> Take Yo'ilmlte Ave West. Hospital will be on right, <br /> �^ <br /> I <br /> *Note, Attach a map to the hospital to this form <br /> Fire Department 911 <br /> Project Health and Safety,V1gr Colleen Dalton Phone # (954) 670.5885 ' <br /> Pager (800) 791-24,2 <br /> Industrial Hygiene/Safety Specialists (713) 676-4773 or (713) 676-4743 <br /> I <br /> E i � <br /> E <br /> This page must be modified iwhene' er the scope of'work changes and must NOT be used as a stand-alone document <br /> CA100078 qpCOe126196 <br />