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Page 1 <br /> SITE HEALTH AND SAFETY PLAN <br /> Hultgren—Tillis Engineers (H—TE) <br /> I. GENERAL SITE INFORMATION <br /> Site Name: Victoria Island <br /> Site Address: approx. 21000 State Route 4 (Hwy 4), between Old River and Middle River <br /> Contact Person: Jim Jerkovich Phone: 209-465-5600 <br /> Site Identification Number: NA Proposed Date(s) of Site Work: December 17-18, 2007 <br /> II. DESCRIPTION OF ACTIVITY <br /> Purpose of Activity: Type of Site <br /> X Monitoring well installation 0 Industrial <br /> ❑ Gas extraction well installation ❑ Gas station <br /> ❑ Agricultural well installation X Other(specify): farm <br /> ❑ Other(specify): <br /> Provide a brief description of the proposed activities: <br /> 1. H-TE engineer will mark USA white paint for the monitoring well and call USA on Monday <br /> December 10, 2007. <br /> 2. H-TE engineer and subcontract driller will drill, log and sample one hollow-stem auger <br /> boring about 80 feet deep at the location of the receiving shaft. H-TE engineer and <br /> subcontract driller will convert that geotechnical boring into a 2"monitoring well, sand filter, <br /> bentonite seal, and neat cement grout above, with flush cover box. <br /> Investigation-derived material disposal: <br /> Soil: soil cuttings may either be removed or spread out on the existing levee near the proposed <br /> intake site. <br /> Water and Fluids: Fluids to be removed from the site by subcontract driller. <br /> Other: NA <br /> III. POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Potential Hazards include: <br /> Heat(high ambient temperature) <br /> Fog (traffic hazards esp. on Hwy 4) Heavy equipment <br /> Slopes (traffic hazards on farm) physical injury/trauma resulting from moving machinery <br /> Slippery and/or Bumpy Roads <br /> Falls, trips, slips <br /> Mosquitoes <br /> Dust General construction <br /> Noise physical injury and trauma <br /> electrical hazards—nearby overhead wires <br /> underground utilities <br />