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u:oTC <br /> Appendix 7-4 <br /> Form HS 003 <br /> ENVIRONMENTAL SITE SAFETY PLAN <br /> Important: Please forward one copy of completed document to the reviewer three (3)working days prior to <br /> project start up and maintain a copy on site. Palace signed copy in project file. Items marked with <br /> "1910.120..."are required by 29 CFR 1910.120 in the paragraph noted. . <br /> A. GENERAL INFORMATION (1910.120(c)(4)) <br /> Project Name Former Cheaper Store#37 Project Number 54.25847.0037 <br /> Project Manager Drew Van Allen <br /> Print Signature <br /> Site or Building Name <br /> Address - 15 East Grant Line Road <br /> City, State & Zip Tracy, CA <br /> Client Contact Name and Phone John Johnson <br /> Number (707) 745-6691 <br /> Fire #: 911 Police #: 911 Ambulance #: 911 <br /> Nearest Hospital Name Sutter Tracy Community Hospital (209) 835-1500 <br /> Address 1420 North Tracy Blvd, Tracy, CA <br /> Directions to Hospital Turn right (west) onto East Grant Line Rd. Turn left (south) onto North <br /> Tracy Blvd. Arrive 1420N Tracy Blvd <br /> Location of Nearest Phone Cell phone <br /> (and special dialing instructions if any) <br /> Directions for Emergency Escape NA <br /> (attach diagram if necessary) <br /> Designated Reporting Area NA <br /> (after emergency occurrence) <br /> B. SITE DESCRIPTION (1910.120(c)(4)) <br /> Facility History: <br /> Facility has a known release of petroleum hydrocarbons. High concentrations of gasoline, <br /> benzene, MTBE have been detected in groundwater beneath the site. <br /> Type of Hazard Anticipated On Site (i.e. tanks, drums, etc.): <br /> Current 'filling station with gasoline USTs in same location as former tanks. Petroleum <br /> hydrocarbon vapors expected in area. Fire hazard, inhalation, ingestion and contact hazards. <br /> i <br />