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Page 1 <br /> SITE HEALTH AND SAFETY PLAN <br /> Hultgren—Tillis Engineers (H—TE) <br /> I. GENERAL SITE INFORMATION <br /> Site Name: Staten Island(APN 069-02-019) <br /> Site Address: 20250 N. Staten Island Road, Thorton, California <br /> Contact Person: Dario Leekam Phone: 805-341-3907 /925-685-6300 <br /> Site Identification Number: 905.03 Proposed Date(s)of Site Work: Feb. 5, 2021 <br /> II. DESCRIPTION OF ACTIVITY <br /> Purpose of Activity: Type of Site <br /> ® Geotechnical Soil Borings 0 Industrial <br /> ❑ Gas extraction well installation ❑ Gas station <br /> ❑ Agricultural well installation ® Other(specify): Empty Land <br /> ❑ Other(specify): <br /> Provide a brief description of the proposed activities: <br /> Drill 2 borings to approximately 30 feet deep, collect soil samples, and backfill borings with <br /> cement grout. <br /> Investigation-derived material disposal: <br /> Soil: soil cuttings may either be removed or spread out near the exploration holes. <br /> Water and Fluids: NA <br /> Other: NA <br /> III. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Potential Hazards include: <br /> Heavy equipment-physical injury/trauma resulting from moving machinery <br /> Fall hazard—physical injury from falling into an excavation>4' <br /> Unshored excavation—physical injury from collapse of sidewalls in an occupied shallow trench<3' <br /> Electrical hazards -nearby overhead wires underground utilities <br /> Slippery and/or Bumpy Roads <br /> Falls, trips, slips <br /> Mosquitoes <br /> Dust <br /> Particulate Matter (PM) from wildfires or other sources <br /> Noise <br /> Uneven, muddy, terrain <br /> HAZARD EVALUATION <br /> Parameter TLV (ppm) IDLH (ppm) LEL (%) skin eyes Health <br /> NA NA NA NA NA <br />