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SITE HEALTH AND SAFETY PLAN <br /> All of the following must be completed. If a different Site Safety Plan is submitted, that Plan must <br /> include the following information. <br /> I. GENERAL SITE INFORMATION <br /> Site Name: Shell Oil Company—Former Central Valley Crude Oil Pipelines Tracy CA <br /> Site Address: Former Shell Pipelines Hansen Road Tracy CA <br /> Contact Person: Michael Hurd Phone: (925) 288-2100 <br /> Site I.D. Number: Proposed Date(s)of Site Work:08/01/01 —08/31/01 <br /> II. DESCRIPTION OF INSPECTION ACTIVITY <br /> Purpose of Activity Tae of Site: <br /> ❑ Monitoring/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) ® Other(specify): Excavated Pipeline <br /> Provide a brief description of the Proposed activities: <br /> Install soil borings in vicinity of removed pipeline to determine extent, if any, of possible hydrocarbon <br /> contamination in area <br /> Investigation-derived material disposal: <br /> Soil: Soil to be stockpiled on site on visqueen until it can be properly disposed of <br /> Water: <br /> Other: <br /> III. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Anticipated physical hazards. Check all that 401v <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 /> SSP0498_DOC/ <br />