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SITE HEALTH AND SAFETY PLAN <br /> L GENERAL SITE INFORMATION _ <br /> Site Name Tosca Former UnocalService Station#4409 <br /> Site Address 1502 North El Dorado Stockton. <br /> Contact Person Mark Capps Phone 916 928-3300 <br /> Site 1 D Number 911.-011 1A Proposed Date(s) of Site Work <br /> II. DESCRIPTION OF INSPECTION ACTIVITY <br /> Purpose of Activity Type of Site <br /> ® Monitonng/extraction well installation ® Retail gas station/former gas station <br /> ❑ Vapor extraction well installation ❑ Petroleum Plant <br /> ❑ Well abandonment ❑ Industrial <br /> ❑ Soil boring/geoprobe/hydropunch ❑ Landfill <br /> ❑ Other (specify) Shallow Excavation ❑ Other (specify) <br /> Provide a brief description of the proposed activities <br /> Install four groundwater monitoring wells using hollow-stem auger drilling equipment <br /> Investigation-denved material disl2osal <br /> Soil stockpiled <br /> Water drums <br /> Other <br /> IH. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Anticipated physical hazards Check all that apply <br /> ❑ Heat (high ambient temperature) ® Heavy equipment <br /> ❑ Cold ® Physical injury/trauma resulting from <br /> ® Noise moving machinery <br /> ❑ Oxygen depletion/asphyxiation <br /> ❑ Excavation cave-ins ® General construction physical injury/trauma <br /> ® Falls, trips, slipping ❑ Electrical hazards <br /> ® Traffic control <br /> ® Overhead hazards ❑ Other (specify) <br /> i <br /> 911-011 1A/0102/SSP3 <br />