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SITE HEALTH AND SAFETY PLAN <br />GENERAL SITE INFORMATION <br />Site Name: New 3 story Addition <br />Site Address: 831 W. Clover Road Tracy <br />Contact Person and Phone Number: <br />Ryan Dean 925-454-9033 (0), 925-381-4752(C) <br />Site Identification Number: <br />Proposed date(s) of Site Work: <br />6/3/22 <br />DESCRIPTION OF INSPECTION ACTIVITY <br />Purpose <br />of Activity: <br />Type <br />of Site: <br />❑ <br />Monitoring well installation <br />❑ <br />Industrial <br />❑ <br />Gas extraction well installation <br />❑ <br />Gas Station <br />❑ <br />Domestic well installation <br />❑ <br />Landfill <br />❑ <br />Agricultural well installation <br />■ <br />Commercial <br />■ <br />Geotechnical Investigation <br />❑ <br />Open Lot <br />❑ <br />Other (specify): <br />❑ <br />Other (specify) <br />Provide a brief description of the proposed activities: <br />Three vertical soil borings up to 30 feet below existing grade <br />Investigation -derived material disposal: <br />Soil: to be disposed on site <br />Water: to be disposed on site <br />Other: <br />POTENTIAL HEALTH AND SAFETY HAZARDS <br />Anticipated physical hazards. Check all that apply. <br />❑ heat (high ambient temperature) <br />❑ cold <br />■ noise <br />❑ oxygen depletion <br />❑ asphyxiation <br />❑ excavation <br />❑ cave-in <br />■ falls, trips, slipping <br />Open Lot <br />Heavy Equipment <br />■ physical injury/ moving machinery <br />❑ General Construction <br />❑ physical injury and trauma <br />■ electrical/underground hazards <br />❑ Other (specify): <br />