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i <br /> SCHUTZE&ASSOCIATES,INC <br /> 44358 S GRIMMER BOULEVARD FREMONT CA 94535 0 TELEPHONE:(51 O)226-9944 O FAX(51 O)226-9948 <br /> SITE HEALTH AND SAFETY PLAN <br /> I. GENERAL SITE INFORMATION <br /> Site Name: Commercial Property <br /> Site Address: 2327 East Mariposa Road Stockton CA 95205 <br /> Contact Person: Mr. Jan Schutze Phone: 510-226 9944 <br /> Site Identification No.: SCS700.4 Proposed Date of Work: October 15,2020 <br /> II. DESCRIPTION OF ACTIVITY <br /> Purpose of Activity Tvve of Site <br /> ❑ Monitoring Well Installation X Industrial/Commercial <br /> X Geoprobe Drilling ❑ Gas Station <br /> ❑ Domestic Well Installation ❑ Dry-Cleaners <br /> ❑ Agricultural Well Installation ❑ Landfill <br /> ❑ Other ❑ Other <br /> Provide a brief description of the proposed activities: <br /> Advancing up to 4 soil borings to 15ft and advancing 0 to 2 soil borings to 60 ft• collecting soil and <br /> groundwater samples• grouting the borings. <br /> Investigation-derived material disposal: <br /> Soil: stored in DOT approved containers (55 gal drum or 5-gal bucket with lid) on-site pending waste <br /> characterization <br /> Water: N/A <br /> III. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Anticipated Physical Hazards: <br /> ❑ Heat(high ambient temperature) X Heavy equipment <br /> ❑ Cold X Physical injury/trauma resulting <br /> X Noise from moving machinery <br /> ❑ Oxygen depletion X General construction <br /> ❑ Asphyxiation X Physical injury/trauma <br /> ❑ Electrical hazards <br /> X Falls,trip, slipping <br /> ❑ Excavation ❑ Potential fire or explosion <br /> ❑ Cave-ins <br /> ❑ Falls,trip, slipping <br /> X Other(specify): COVID <br /> Health& Safety Plan <br /> Page 1 <br />