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SITE INSJ, ECTION LOG/HASP SIGNAlltRE PAGE <br />PROJECT NAME: 54 North Cluff Avenue LOCATION: 54 North Cluff Avenue, Lodi, CA <br />PROJECT NUMBER: DATE: 6/28/2017 <br />PROJECT MANAGER: Joe Mangine COMPLETED BY: Nate Maroon <br />SITE DESCRIPTION AND NATURE OF WORK: Install four temporary sub-slab soil gas probes to facilitate the collection and analysis of soil gas samples. The <br />probes will be installed inside the subject property bidding. A direct-push rig will be used for installation of the probes and collection of soil gas samples. <br />HAZARD COMMUNICATION <br />[X] Chemical hamds identified <br />[NA]All containers properly labeled <br />[NA] MSDS/workplace notebook on-site <br />[X] Site safety briefing completed and documented <br />ACCIDENTS/EMERGENCY INFO <br />[X] First aid personnel identified <br />[X] Hospital location identified <br />[X] Police/fire/ambulance phone numbers available <br />[NA] Fire extinguisher present <br />STORAGE <br />[X] Tools/drill equipment/supplies safely stacked to prevent <br />rolling or collapse <br />[X] Work areas and passage ways kept clear <br />UNDERGROUND HAZARDS <br />[X ]All underground hazards identified and communicated to <br />workers on-site <br />[X]Utility/USA clearance confirmed <br />[X]Clearance dates: <br />[X]Clearance ID#: <br />OVERHEAD HAZARDS <br />[X] 15-foot minimum clearance maintained <br />[X] All sources of falling objects/swinging loads/ <br />rotating equipment identified <br />[X] Barriers or other methods in place to prevent injury due to <br />overhead hazards <br />EXCAVATIONS and TRENCHES <br />[X] All personnel and storage at least 2 feet from top edge of <br />excavation <br />[NA] Ladder in place <br />[X] Guarding/barriers in place <br />VEHICULAR TRAFFIC <br />[X] All vehicular traffic routes which could impact worker <br />safety identified and communicated <br />[X] Barriers or other methods established to prevent injury from <br />moving vehicles <br />PEDESTRIAN 'TRAFFIC/SITE CONTROL <br />[NA] All walkways which could be impacted by site activities <br />identified and communicated <br />[X] Barriers or other methods established to prevent pedestrian <br />injury from site activities <br />AIR MONITORING <br />[X] P1D on-site for air monitoring of work breathing space <br />[X] HD calibrated daily and recorded in log book <br />[X] Operational action levels communicated and PPE present <br />for use, if required <br />COMMENTS/OTHER HAZARDS <br />x = OK NA = Not Applicable <br />Partner Site-Specific Heald] and Safety Plan Page 12 <br />Version 1.02 June 28, 2017