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I I <br /> x DRAFT <br /> SITE HEALTH AND SAFETY PLAN <br /> I. GENERAL SITE INFORMATION <br /> Site Name: Parkinson's Hammer I5 Arco <br /> Site Address: 3250 West Hammer Lane, Stockton <br /> Contact Person: Kathleen Waldo Phone: (916) 928-3300 <br /> Site I.D. Number: 880-040.1A Proposed Date(s) of Site Work: <br /> II. DESCRIPTION OF INSPECTION ACTIVITY <br /> Purpose of Activity: Type 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) Shallow Excavation ❑ Other(specify): <br /> Provide a brief description of the proposed activities: <br /> Completion of cone penetrometry test borings and installation of groundwater monitoring wells. <br /> Investigation-derived material disposal: <br /> Soil: stockpiled <br /> Water: drums <br /> Other: <br /> a <br /> III. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Anticipated physical hazards. Check all that ably. <br /> ❑ Heat (high ambient temperature) ® Heavy equipment <br /> ❑ Cold ® Physical.injury/trauma resulting from <br /> ® Noise moving machinery <br /> ❑ Oxygen depletion/asphykiation <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 /> i <br /> \\SACRFP 1\COMMON\rancfp l\Proj ects\Proj ects\880\040\l a\0102\SSP.doc <br />