Laserfiche WebLink
(MUC <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. Place 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 Van Allen& East Bushka Road Project Number 54.33778.0005 <br /> Project Manager Jeanne Homsey <br /> Print Signature <br /> Site or Building Name AWS "Van Allen& East Bushka Road" <br /> Address 17327 South Van Allen Road <br /> City, State & Zip Escalon, CA 95320 <br /> Client Contact Name and Phone <br /> Number <br /> Fire #: 911 Police #: 911 Ambulance #: 911 <br /> Nearest Hospital Name Emmanuel Medical Center <br /> Address 1441 Florida Avenue, Modesto (209) 578-1211 <br /> Directions to Hospital South on Van Allen to Highway 120, turn left. East on Hwy 120 to McHenry, turn right. <br /> South on McHenry to Orangeburg, turn right. West on Orangeburg (one block) to <br /> Florida, turn right. <br /> Location of Nearest Phone In house on site, and cell phone in ATC truck <br /> (and special dialing instructions if any) <br /> Directions for Emergency Escape Return to driveway on site and move towards S. Van Allen <br /> Road <br /> (attach diagram if necessary) <br /> Designated Reporting Area South end of site driveway, at S. Van Allen Road <br /> (after emergency occurrence) <br /> B. SITE DESCRIPTION (1910.120(c)(4)) <br /> Facility History: <br /> Farmhouse and barn with two former USTs for fueling farm equipment. USTs removed in late <br /> 1980s. <br /> Type of Hazard Anticipated On Site (i.e. tanks, drums, etc.): <br /> Potential for petroleum-impacted soil. Small ("200 gallon) Above-ground fuel tank near work area <br />