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SITE HEALTH AND SAFETY PLAN <br />Complete all the following information. If a different Site Safety Plan is submitted, that Plan must include the <br />following information: <br />I. GENERAL SITE INFORMATION <br />Site Name: Stockton Rehab Hospital <br />Site Address: N. California Street/E. Magnolia Street, Stockton, CA <br />Contact Person: Christopher Cecile Phone: (510) 376-1386 <br />Site Identification Number: 13921008 Proposed Date(s) of site work: <br />DESCRIPTION OF INSPECTION ACTIVITY <br />Purpose of Activity: <br />El Monitoring well installation <br />El Gas extraction well installation <br />El Domestic well installation <br />Agricultural well installation <br />()fl Other (specify): Geotechnical Investigation <br />Type of Site: <br />DIndustrial <br />IGas station <br />El Landfill <br />Q..0ther (specify): Hospital <br />Provide a brief description of the proposed boring activities: <br />Investigation-derived material disposal: <br />Soil: 55-gal drum <br />Water: 55-gal drum <br />Other: N/A <br />III. POTENTIAL HEALTH AND SAFETY HAZARDS <br />Anticipated physical hazards. Check all that Apply. <br />S-heat (high ambient <br />temperature) <br />El cold <br />g noise <br />LI oxygen depletion <br />CI asphyxiation <br />El Excavation <br />El cave-ins <br />'7-falls, trips, slipping <br />.< Heavy equipment <br />>4physical injury/trauma resulting from moving machinery <br />General construction <br />[4. physical injury and trauma <br />CI electrical hazards <br />.61.. Other (specify):