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Home My WebLink About3203; TAM- CSBD TO JEFF- REDESIGN; SOIL ANALYSIS FORMS;/ Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine. the soil type(s) present In .the excavation. A separate. analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. DATE: TIME: (2 COMPETENT PERSON: S-vL— LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): X COARSE GRAINED (Sand/Gravel)— WATER CONDITIONS: WET._. DRY. SURFACE WATER PRESENL.L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL yes4o LAYERED SOILS? Yej LAYERED SOIL DIPPING INTO EXCAVATION? Ye3 EXCAVATION EXPOSED TO VIBRATIONSj1Nb IF YES, DESCRIBE: lFFIt CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Yes) CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye&)lF YES, DESCRIBE: SURFACE ENCUMBRANCES? YeNà )IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? sjo POSSIBLE CONFINED SPACE EXPOSURE? Ye)If YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: 04 kt' TIME: -)CCMPErafr PERSON:___________________ LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ ... pgnatureL ID1t VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):)( COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET_ DRY SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOiL3No LAYERED SOILS? YesJ LAYERED SOIL DIPPING INTO EXCAVATION? Yes) EXCAVATION EXPOSED TO ViBRATIONST?No IF YES, DESCRIBE: Tpi- CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Yesk 09 CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye )F YES, DESCRIBE: SURFACE ENCUMBRANCES? Yes3 IF YES, DESCRIBE: .WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? Qo POSSIBLE CONFINED SPACE EXPOSURE? Ye )If YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE:04i'Z,,'t) TIME:_?xD COMPETENT PERSON ' MAt.LOc. LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): COARSE GRAINED (Sand /Gravel), WATER CONDITIONS: WET_ DRiX SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOILl LAYERED SOILS? Yes) LAYERED SOIL DIPPING INTO EXCAVATION? YedLNo EXCAVATION EXPOSED TO VIBRATIONSISNo IF YES, DESCRIBE: AFF- CRACK-LIKE OPENINGS OR SPAWN SPAU.ING OBSERVED? Yes CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye3 IF YES, DESCRIBE: SURFACE ENCUMBRANCES? YestIF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?(No POSSIBLE CONFINED SPACE EXPOSURE? Yes)f YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over' a distance where soil type may change. The following information refers to the site location On the attached checklist. DATE: OLf I2-\V2) TIME: 20 COMPErENIPERSON:___________________ ç) Jrintç71/g. LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: 1-7+9 7 1 AWK1 AVE., VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): X COARSE GRAINED (SandfGravel):____ WATER CONDITIONS: WET DRY. SURFACE WATER PRESENT L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?~eo LAYERED SOILS? Ye3 LAYERED SOIL DIPPING INTO EXCAVATION? Yes) EXCAVATION EXPOSED TO VlBRATlONS?No IF YES, DESCRIBE: 1AFF CRACK-LIKE OPENINGS ORSPALLING OBSERVED? Yesto . . CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YejF YES, DESCRIBE: SURFACE ENCUMBRANCES? YesjAF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?yNo POSSIBLE CONFINED SPACE EXPOSURE? Ye)If YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for'Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) . This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: _04\14 't?3 TIME: COMPETENT PERSON: . to u- LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):)( COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET ..X DRY_ SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yes3 LAYERED SOILS? Ye LAYERED SOIL DIPPING INTO EXCAVATION? Ye EXCAVATION EXPOSED TO VIBRATIONS'No IF YES, DESCRIBE: .CRACK-LIKE OPENINGS OPENINGS OR SPAWN SPALLINQ OBSERVED? Yeqe CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ve3IF YES, DESCRIBE: SURFACE ENCUMBRANCES? Yes9IF YES, DESCRIBE: . .WORK TO BE PERFORMED NEAR PUBUC VEHICULAR TRAFFIC?o POSSIBLE CONFINED SPACE EXPOSURE? Ye)f YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis Is made to determine the soil type(s) present In .the excavation. A separate analysis nust be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on. the attached checklist. DATE: 0Lth4 \4) TIME: 11 CCMPErENT PERSON: _0B- S(A-( ALLOC-tC Mont Aga- LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: IWONOW Ave VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive)- X COARSE GRAINED (Sand/Gravel): WATER CONDITIONS: WET..X DRY_ SURFACE WATER PRESENT ...L.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL - o . LAYERED SOILS? Ye) LAYERED SOIL DIPPING INTO EXCAVATION? Ye6) EXCAVATION EXPOSED TOVIBRATIONS1O IF YES, DESCRIBE: (PFFIC CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Ye). . CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yes)IF YES, DESCRIBE SURFACE ENCUMBRANCES? YesjlF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC /00~ , 15~ POSSIBLE CONFINED SPACE-EXPOSURE? Yes)lf YES, is company program in effect? Yes'No Page 1 of 2 1 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (to be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2)if excavation is stretched over a distance where soil type may change. The following Information refers to the, site location on the attached checklist. DATE: TIME: COMPETENT PERSON: _iROBIZ-i Pt.1/ LOCATION IN EXCAVA11ON WHERE SAMPLE WAS TAKEN:_ VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):___ COARSE GRAINED (SandlGravel):X WATER CONDITIONS: WET .X. DRY_ SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOILlNo LAYERED SOILS?(o LAYERED SOIL DIPPING INTO EXCAVATION? Yes) EXCAVATION EXPOSED TO VIBRATIONS sJo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPA WNG OBSERVED CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YesQio YES, DESCRIBE: SURFACE ENCUMBRANCES? Yej/NojF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC ?ØJ6 POSSIBLE CONFINED SPACE EXPOSURE? ve6) If YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used foi Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to-determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: I2) TIME:_COMPErENIPERSON: ORrSCI-IA& LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: °'1ii4.$LV VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive)-_.X_COARSE GRAINED (Sand/Gravel):) WATER CONDITIONS: WET_ DRYX SURFACE WATER PRESENT .L. SUBMERGED_. PREVIOUSLY DISTURBED SOIL?Yeqto LAYERED SOILS? YëS() LAYERED SOIL DIPPING INTO EXCAVATION? Ye) EXCAVATION EXPOSED TO VlBRATIONSf3No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Yesi) CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yej)F YES, DESCRIBE: SURFACE ENCUMBRANCES? YeIF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? Ye POSSIBLE CONFINED SPACE EXPOSURE? O/No YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to' show CaYOSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis Is made' to determine the soil type(s) present In .the excavation. A separate analysis 'must be pei'formed: (1) on each layer of soil in excavation walls and (2) If excavation is stretched over a distance where soil type may change. The. following Information refers to the, site location on the attached checklist. DATE: 041 TIME: COMPETENT PERSON:R)W-Ia.T Q-.44 A intyP LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ -fXXM'' VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):)ç COARSE GRAINED '(Sand/Gravel).- _ WATER CONDITIONS: WET_ DRY.X. SURFACE WATER PRESENT ...L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Ye . . . LAYERED SOILS? Yes3 LAYERED SOIL DIPPING INTO EXCAVATION? Yes) EXCAVATION EXPOSED TO VIBRATIONS? NO IF YES, DESCRIBE: T,Ai9c CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Ye . . CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yej)IF YES, DESCRIBE: SURFACE ENCUMBRANCES? Yes (N6 IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? Yese POSSIBLE CONFINED SPACE EXPOSURE? YeqDo YES, is company program in effect? Yes/No Page 1 of 2 I Sample Form to be used for Documentation Purposes to show Cal/OS HA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis Is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: O+(O TIME: 1: O COMPErENTPERSON:_Ro,r LI_cr (Print) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: 2! -,--o ,4a VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive)-_X_ COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET..._. DRYX SURFACE WATER PRESENT..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Ye LAYERED SOILS? Yes) LAYERED SOIL DIPPING INTO EXCAVATION? Ye) EXCAVATION EXPOSED TO VIBRATIONS? No IF YES, DESCRIBE: __Zi ______________________ CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Yes CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)F YES, DESCRIBE: SURFACE ENCUMBRANCES? YeNq)IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFlC?sJo POSSIBLE CONFINED SPACE EXPOSURE? Ye If YES, is company program in effect? Yes/No Page 1of2 I Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. DATE: 0410q-14 TIME: 12S COMPETENT PERSON:_R)SSI?.T LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ f VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):)( COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET_... DRY X SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yej) LAYERED SOILS? Yes& LAYERED SOIL DIPPING INTO EXCAVATION? Ye) EXCAVATION EXPOSED TO VIBRATIONSNo IF YES, DESCRIBE: TJFpl CRACK-LIKE OPENINGS OR SPAUJNG OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)IF YES, DESCRIBE: SURFACE ENCUMBRANCES?JNo IF YES, DESCRIBE: Atsf>iApur J12.EMoVX' WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? QNo POSSIBLE CONFINED SPACE EXPOSURE? Ye o If YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers, to the. site location on the attached checklist. DATE: Ot\) TIME: COMPETENT PERSON: ___J.LLEX.K W-VT R, (Signature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:- VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):X COARSE GRAINED (Sand/Gravel): WATER CONDITIONS: WET_ DRY SURFACE WATER PRESENT_ SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yes) LAYERED SOILS? Yes& LAYERED SOIL DIPPING INTO EXCAVATION? Yej 'T1 zrs EXCAVATION EXPOSED TO VlBRATlONSZNo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPAWN SPALLINQ OBSERVED? Ye CONDITIONS THAT MAY. CREATE A HAZARDOUS ATMOSPHERE? Ye)F YES, DESCRIBE: SURFACE ENCUMBRANCES/No IF YES, DESCRIBE: P21_9Atti1_fj4to/L WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?co POSSIBLE CONFINED SPACE EXPOSURE? Ye4f YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: O13t4 TIME: 140 CCMPErEWr PERSON: _—) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ fop, ¶ VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive).-__X_ COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET L.. DRY J( SURFACE WATER PRESENT_ SUBMERGED_.... PREVIOUSLY DISTURBED SOIL?Ye LAYERED SOILS? Yej LAYERED SOIL DIPPING INTO EXCAVATION? Yesg) EXCAVATION EXPOSED TO VIBRATIONSNo IF YES, DESCRIBE: I CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Yesoo CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)lF YES, DESCRIBE: SURFACE ENCUMBRANCES@No IF YES, DESCRIBE: ASA&r I fEMO( WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?cJo POSSIBLE CONFINED SPACE EXPOSURE? Ye)f YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. DATE:03 TIME: 3000MPETENT PERSON: LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ s / (Signature) VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): )< COARSE GRAINED (Sand/Gravel): WATER CONDITIONS: WET. DRY..X... SURFACE WATER PRESENT_ SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Ye€ LAYERED SOILS? YesJ LAYERED SOIL DIPPING INTO EXCAVATION; Yesi EXCAVATION EXPOSED TO VlBRATIONS'No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLINQ OBSERVED? YesUo CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yes)IF YES, DESCRIBE: SURFACE ENCUMBRANCESrYes4Io IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? &NO POSSIBLE CONFINED SPACE EXPOSURE? Ye If YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis 'must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: TIME: CCMPErENTPERSON: _Or intg LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: _23 L VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):X COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET( DRY SURFACE WATER PRESENT SUBMERGED PREVIOUSLY DISTURBED SOIL?Yes/ LAYERED SOILS? Yesoo LAYERED SOIL DIPPING INTO EXCAVATION? Yesj) EXCAVATION EXPOSED TO VIBRATIONS?No IF YES, DESCRIBE: TFPt CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Yes CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye6 IF YES, DESCRIBE: SURFACE ENCUMBRANCES(YesNo IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? .o POSSIBLE CONFINED SPACE EXPOSURE? Ye If YES, is company program in effect? Yes'No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present in the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: TIME: TIME: COMPErENTPERSON: OI2T SCL\LXi ,(Siqnature) LOCATION IN EXCAVATION j WHERE SAMPLE WAS TAKEN:_ / Tl//t ,-W - VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):)( COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET..& DRY_ SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL7No LAYERED SOILS? Yes) LAYERED SOIL DIPPING INTO EXCAVATION? Yej) EXCAVATION EXPOSED TO VIBRATIONS'?'No IF YES, DESCRIBE: TgA.Fpk. CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Yelto CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YeI.)F YES, DESCRIBE: SURFACE ENCUMBRANCES?&/No IF YES, DESCRIBE: A~F!,'At.r /,nouiff WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?o POSSIBLE CONFINED SPACE EXPOSURE? Yes If YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis Is made to determine the soil type(s) present In -the excavation. A separate analysis must be pei'formed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: Q3 43 TIME: CCMPETENTPERSON: 4PLL.e (Signature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: _ '2.* I TAt(t VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):X COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET DRY_ SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?9sJo LAYERED SOILS? Ye3 LAYERED SOIL DIPPING INTO EXCAVATION? Ye EXCAVATION EXPOSED TO VlBRATIONSNo IF YES, DESCRIBE: tFF1 CRACK-LIKE OPENINGS OR SPAWN SPALLING OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Y(~Do. YES, DESCRIBE: SURFACE ENCUMBRANCES?rNo IF YES, DESCRIBE: ASP#164t-T /dE 014D t.Eb WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?No POSSIBLE CONFINED SPACE EXPOSURE? YeeIf YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis must 'be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: TIME: CCMPErENT PERSON: _?C512i ALL'- Pa .(Prt) :4z:;" nAtu LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ 7iV VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):) COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET DRY_ SURFACE WATER PRESENT .L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL1J/No LAYERED SOILS? Yes& LAYERED SOIL DIPPING INTO EXCAVATION? Yes(s) EXCAVATION EXPOSED TO VIBRATIONS? €No IF YES, DESCRIBE: 7,4Ftc CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yes()lF YES, DESCRIBE: SURFACE ENCUMBRANCES? No IF YES, DESCRIBE: ASPI4ALT 1M OVb WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? POSSIBLE CONFINED SPACE EXPOSURE? YeIf YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used 16r' Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. ifor A separate analysis 'must be pemed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. DATE: O1i'143 TIME: '162 COMPETENT PERSON: _Rop-c LOCATION IN IN EXCAVATION WHERE SAMPLE WAS TAKEN: _2 i10 i- VISUAL VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):)( COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET .1 DRY_ SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL? Jo PN LAYERED SOILS? Yej) LAYERED SOIL DIPPING INTO EXCAVATION? Yes EXCAVATION EXPOSED TO VIBRATIONSNo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLINQ OBSERVED? Ye3 CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yesg) IF YES, DESCRIBE: SURFACE ENCUMBRANCES'YesNo IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? 6~o POSSIBLE CONFINED SPACE EXPOSURE? Yef YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis Is made to determine the soil type(s) present In the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. DATE: TIME :".%O_ COMPETENT PERSON: ________________ (~o I L (P. nU,& LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ Ave, VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET_X DRY_ SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOILJNo LAYERED SOILS? Yej LAYERED SOIL DIPPING INTO EXCAVATION? Ye sj) EXCAVATION EXPOSED TO VIBRATIONSf3No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPAWN SPALLING OBSERVED? Yes CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yes)lF YES, DESCRIBE: SURFACE ENCUMBRANCES'No IF YES, DESCRIBE: PPMAL-T f.EA,tOVE7 WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?sJo POSSIBLE CONFINED SPACE EXPOSURE? YesJ) If YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show CaUOSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis rnust be peiformed: (1) on each layer of soil in excavation walls and (2) If excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE:03 ii V13 TIME: -7:--30 COMPETENT PERSON:orr t-wcwk. LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): )ç COARSE GRAINED -(Sand/Gravel)- WATER CONDITIONS: WET DRY_ SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOILNo 501ma LAYERED SOILS? YeJ LAYERED SOIL DIPPING INTO EXCAVATION? Ye9 EXCAVATION EXPOSED TO VIBRATIONSNo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLINQ OBSERVED? Yes(e CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)F YES, DESCRIBE: SURFACE ENCUMBRANCESYe'No IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC 'No POSSIBLE CONFINED SPACE EXPOSURE? Ye6)If YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show CaVOSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) •. . - This checklist should be completed when soil analysis Is made to determine the soil type(s) present In the excavation. A separate analysis must be pei formed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: TIME: COMPETENT PERSON:_R'3r Sc44ALLI,cr- nW 0 V-4 LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: _Z 4& 4 L 3;,(siatureLj.. A . VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): k COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET DRY SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL? 32- # 4 .Y3 ?0,1-00,V6 LAYERED SOILS LAYERED SOIL DIPPING INTO EXCAVATION? Yeloo EXCAVATION EXPOSED TO VIBRATIONS- &o IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPAWN SPALLING OBSERVED? Ye . CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)F YES, DESCRIBE: SURFACE ENCUMBRANCES?Jo IF YES, DESCRIBE: ASP,MvT /iPEMovri2 WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? &eo POSSIBLE CONFINED SPACE EXPOSURE? Ye O/No f YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to. show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE:____________ TIME: COMPErENTPERSON:_•ROET J-44li0i - —r- (SLgnawre.) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ "' VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): V COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET_ DRY ....L SURFACE WATER PRESENT..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL No . . LAYERED SOILS? Yes(s) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Ye6 . . CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YejF YES, DESCRIBE: SURFACE ENCUMBRANCES(YéNo IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?No POSSIBLE CONFINED SPACE EXPOSURE? Ye0oIf YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis 'must be performed: (1) on each layer of soil in excavation walls and (2) If excavation is stretched over a distance where soil type may change. The following Information refers to. the site location on the attached checklist. 12 DATE:C )'2/q3 TIME: 1`50 COMPETENT PERSON: _0BIT SCMALLJ7C(C_ ,r PrintK. Ai kt L ct3eXo eL LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):')( COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET_ DRY Y' SURFACE WATER PRESENL.. .. SUBMERGED_ PREVIOUSLY DISTURBED SOlLNo . LAYERED SOILS? YeJ) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS3/No IF YES, DESCRIBE: AIC CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yes3F YES, DESCRIBE: SURFACE ENCUMBRANCES? No IF YES, DESCRIBE: ASPAT - MO\tET) WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? Jo POSSIBLE CONFINED SPACE EXPOSURE? Ye If YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation -Purposes to show Cal/OS HA . SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis nust be peformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: O3IO TIME: COMPETENT PERSON: LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):)( COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET_ DRY_.X SURFACE WATER PRESENT_ SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yeoo . . LAYERED SOILS? Yes& LAYERED SOIL DIPPING INTO EXCAVATION? Yesip EXCAVATION EXPOSED TO VlBRATIONS3lNo IF YES, DESCRIBE: TPI4FAC CRACK-LIKE OPENINGS OR SPAWN SPALLING OBSERVED? Ye . CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)lF YES, DESCRIBE: SURFACE ENCUMBRANCES? Yes/No IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? Ee ONo POSSIBLE CONFINED SPACE EXPOSURE? Yed YES, is company program in effect? Yes/No Page 1 of 2 I Sample Forn to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be peformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. - The following Information refers to the site location on the attached checklist. DATE: O31 l) TIME: COMPETENT PERSON:_ LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ 1?4. VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): X COARSE GRAINED (Sand/Gravel): WATER CONDITIONS: WET. DRYX SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yesi LAYERED SOILS? Ye LAYERED SOIL DIPPING INTO EXCAVATION? Yeso EXCAVATION EXPOSED TO VIBRATIONS? Jo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yq)IF YES, DESCRIBE: SURFACE IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?Jo POSSIBLE CONFINED SPACE EXPOSURE? YeIf YES, is company program in effect? Yes/No Page 1 of 2 It / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis nust be peformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: TIME: COMPETENT PERSON: Vxt,._T&AdAcfc TA A A SJatycaL LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: —ZS '' "''' VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):___ COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET_ DRYI SURFACE WATER PRESENT SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Ye LAYERED SOILS? Ye3 LAYERED SOIL DIPPING INTO EXCAVATION? Ye) EXCAVATION EXPOSED TO VlBRATIONSJo IF YES, DESCRIBE: T4fF1c CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)IF YES, DESCRIBE: SURFACE ENCUMBRANCES(Y4o IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? No POSSIBLE CONFINED SPACE EXPOSURE? Yejlf YES, is company program in effect? Yes/No Page 1 of 2 It / Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM. (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached. checklist. DATE:Ofr TIME: COMPETENT PERSON: _i SPU.4 ,C# ignature LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_' hw VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive).-_'y COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET_ DRY..X. SURFACE WATER PRESENT .L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yes . LAYERED SOILS? Yes00LAYERED SOIL DIPPING INTO EXCAVATION EXCAVATION EXPOSED TO VlBRATIONSçftSJo IF YES, DESCRIBE: ________________________ CRACK-LIKE OPENINGS OR SPAWN SPALLINQ OBSERVED? Ye . CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye€)F YES, DESCRIBE: SURFACE ENCUMBRANCES1'fea)No IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC jNo POSSIBLE CONFINED SPACE EXPOSURE? Yea)f YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used f6r Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present in -the excavation. A separate analysis must be pei'formed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following. information refers to the site location on the attached checklist. DATE: )3 O*f TIME: compErENT Sftkth.fC . -L 1(nature LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: VISUALTEST PARTICLE TYPE: FINE GRAINED (Cohesive):K COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET. DRY SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL 3No . • . LAYERED SOILS? Ye LAYERED SOIL DIPPING INTO EXCAVATION? EXCAVATION EXPOSED TO VIBRATIONS?JNo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Yeso CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yej)F YES, DESCRIBE: SURFACE ENCUMBRANCESJNo IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? No POSSIBLE CONFINED SPACE EXPOSURE? vesj)it YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation* Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis 'must be peiiormed: (1) on each layer of soil in excavation walls and (2) If excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: O3\ TIME: _COMPETENT PERSON: 1W'14 _SrL2C1(_ ID_(P!fl.4 LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: _Th4e4.- r. VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): 'K COARSE GRAINED(Sand/GraveI):___ WATER CONDITIONS: WET DRY)( SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOILfJNo . . . LAYERED SOILS? Yes/No LAYERED SOIL DIPPING INTO EXCAVATION? Jo EXCAVATION EXPOSED TO VIBRATIONS'No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLINQ OBSERVED? Yelo CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YJ)F YES, DESCRIBE: SURFACE ENCUMBRANCES?9No IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? SNO POSSIBLE CONFINED SPACE EXPOSURE? YesIf YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be pei'formed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: U'-,7 1\4 TIME: 14 COMPETENT PERSON: & 12 _A &0 ., IC LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: _f•33• _Ai'—& PT. VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):Y COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET_. DRY SURFACE WATER PRESENT SUBMERGED_ PREVIOUSLY DISTURBED SOI . Ye o LAYERED SOILS? Yes/No LAYERED SOIL DIPPING INTO EXCAVATlON?Jo EXCAVATION EXPOSED TO VlBRATlONSJo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OPENINGS OR SPALLING OBSERVED? ye3 CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YesF YES, DESCRIBE: SURFACE ENCUMBRANCES 14No IF YES, DESCRIBE: A PH1i1-7 WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? No POSSIBLE CONFINED SPACE EXPOSURE? Yes) YES, is company program in effect? YesNo Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed• Daily by Competent Person). This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis must be pe1ormed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the, site location on the attached checklist. DATE: `25 TIME:Th_ COMPETENT PERSON: RLM312c (Print)(Print) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_29-f 0 TM1 a Pfl#'(r VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive).-_)L COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET DRYI.. SURFACE WATER PRESENT .L. SUBMERGED_. PREVIOUSLY DISTURBED SOIL?Ye , LAYERED SOILS? Yes(9 LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATlONS13fNo IF YES,.DESCRIBE: CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Ye49 CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YeJ) IF YES, DESCRIBE: SURFACE ENCUMBRANCES? Yes/No IF YES, DESCRIBE: _________________________________ WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? 9No POSSIBLE CONFINED SPACE EXPOSURE? Yef YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: 0.71\tl\ C3 TIME: .1.30 COMPETENT PERSON:_lOB'r ScLC- n L nature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_215 VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive)-_X_ COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET DRY SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yest LAYERED SOILS? Yes) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONSNo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Yest CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)IF YES, DESCRIBE: SURFACE ENCUMBRANCES? Yes/No IF YES, DESCRIBE: FbW R2L WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? &eo POSSIBLE CONFINED SPACE EXPOSURE? Yes If YES, is company program in effect? Yes/No Page lot 2 It rA Sample Form to be used for Documentation Purj,oses to show Cal/OS HA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis Is made to determine the soil type(s) present In the excavation. A separate analysis must be pei'formed: (1) on each layer of soil in excavation walls and (2) If excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: TIME: 1:3a CCMPENTPERSON:&r --K--. LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): X COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET' DRYX. SURFACE WATER PRESENT.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?YeP LAYERED SOILS? Yej) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS-(q/No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Yes) CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YeJ) IF YES, DESCRIBE: SURFACE ENCUMBRANCES? Yes/No IF YES, DESCRIBE: •1 FOWP__ WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? No POSSIBLE CONFINED SPACE EXPOSURE? Ye)If YES, is company program in effect? Yes/No Page 1 of 2 / 1 Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person). This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be peilormed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. DATE:_ TIME:-1 CCMPErENTPERSON:ICI- O&t'J \ a(''. (Signature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):____ COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET_ DRY' SURFACE WATER PRESENT ...L.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Ye LAYERED SOILS? Yesg LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS &No IF YES, DESCRIBE: T (j CRACK-LIKE OPENINGS OR SPALUNG OBSERVED? Ye& CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye0 YES, DESCRIBE: SURFACE ENCUMBRANCES? Yes/No IF YES, DESCRIBE: 7 . WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?No POSSIBLE CONFINED SPACE EXPOSURE? Ye-16) YES, is company program in effect? Yes/No Page 1 of 2 I - Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the, site location on the attached checklist. DATE: 1n(3 TIME: 7_CCMPEENTPERSON: 01kLL.K (Print) i —r (Sionature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:- VISUAL_TEST PARTICLE TYPE:. FINE GRAINED (Cohesive).-__,X COARSE GRAINED '(Sand/Gravel):___ WATER CONDITIONS: WET_ DRY SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOlL?Yes3 LAYERED SOILS? Ye LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VlBRATlONS9No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)lF YES, DESCRIBE: SMA ENCUMBRANCESJNo IF YES, DESCRIBE: Ft'CE _TEIc_iSF'tALT_bi.&.ti WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? Yes/No POSSIBLE CONFINED SPACE EXPOSURE? Yes/No If YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) ' This checklist should be completed when soil analysis is made to. determine the soil type(s) present In .the excavation. A separate analysis 'must be pei'formed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. DATE: Oz TIME: COMPETENT PERSON: CI-{"\1Lok rin4 (Signature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):X COARSE GRAINED (Sand/Gravel): WATER CONDITIONS: WET tt DRY_ SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOlL?YeJ LAYERED SOILS? YesA3 LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS1J'No IF YES, DESCRIBE: T4FFIc./'Th4M( CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Yest CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yej)IF YES, DESCRIBE: SURFACE ENCUMBRANCESNo IF YES, DESCRIBE: 4.4(Ec ALT WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?No POSSIBLE CONFINED SPACE EXPOSURE? YeaIf YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show CaUOSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when s01 analysis is made to determine the soil type(s) present in .the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: TIM CCMPEIENT PERSON:_O*P-1 AL-16( QIL rin 1AAL (Signature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ 1 4%\Q VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):( COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET ..L. DRY_. SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yes/J LAYERED SOILS? Yes.) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TOVIBRATIONS?No IF YES, DESCRIBE: TAFFf /TPA i,J CRACK-LIKE OPENINGS OR SPAWN SPALLINQ OBSERVED? Ye-& CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye IF YES, DESCRIBE: SURFACE ENCUMBRANCES6No IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? 6No POSSIBLE CONFINED SPACE EXPOSURE? YeIf YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show. Cal/OSHA - SOIL ANALYSIS FORM (To be Completed• Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: TIME:Th3O_ COMPETENT PERSON:Ot1 ck?cuoc.f(_ d7Laic LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ jjUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive):____ COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WE1 DRY_ SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yest LAYERED SOILS? Yes(s) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS? 'No IF YES, DESCRIBE: ,PEIC- 1-P I iJ CRACK-LIKE OPENINGS OR SPALLINQ OBSERVED? YesItC CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yes,JIF YES, DESCRIBE: SURFACE ENCUMBRANCES?(YeiNo IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? (No POSSIBLE CONFINED SPACE EXPOSURE? O/No YES, is company program in effect? Yes/No Page 1 of 2 It / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the, site location on the attached checklist. DATE: TIME:_8:00 COMPEFENT PERSON: SCA44QçY- (Signature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: Tt/4 Av&-. VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): X COARSE GRAINED'(SandlGravel):___ WATER CONDITIONS: WE161 DRY_ SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yeé) LAYERED SOILS? Ye o LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS? (So IF YES, DESCRIBE: 11Fit I IVA It) CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Yes4 CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yej) IF YES, DESCRIBE: SURFACE ENCUMBRANCES/No IF YES, DESCRIBE: fE?PL1 WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? POSSIBLE CONFINED SPACE EXPOSURE? Yes3 If YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed• Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: O2-I0\t TIME: CCMPETBJTPERSON: - . Ignature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: _I _/_/Dj _2_-+ VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive)- )( COARSE GRAINED .(Sand/Gravel)- WATER CONDITIONS: WET DRY_ SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL?Yes3 LAYERED SOILS,to ) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS Jo IF YES, DESCRIBE: 1fF _Tpc1t1 CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Yesoo CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)F YES, DESCRIBE: SURFACE ENCUMBRANCESTYeJo IF YES, DESCRIBE: wT WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?o POSSIBLE CONFINED SPACE EXPOSURE? YesIf YES, is company program in effect? Yes/No Page 1 of 2 I Sample Form to be used for Documentation Purposes to show Cal/OSHA -• SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis- is made to determine the soil type(s) present In the excavation. A separate analysis must be pei'formed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to. the, site location on the attached checklist. DATE:t 2'i (46 TlMEtCb_COMPErENI PERSON:RO13Er S. kPCL.L.00JC- Q.,jont) k il I - • (Sicrnature LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: ' 'I 41 4+l i'f VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): >C COARSE GRAINED '(SandlGravel):_ WATER CONDITIONS: WET' DRY_ SURFACE WATER PRESENT...... SUBMERGED PREVIOUSLY DISTURBED SOILJNo LAYERED SOILS? Yesoo LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VlBRATIONSNo IF YES, DESCRIBE: • CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Ye • CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye3IF YES, DESCRIBE: SURFACE ENCUMBRANCES(YejA'Jo IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?No IrITN POSSIBLE CONFINED SPACE EXPOSURE? Ye If YES, is company program in effect? Yes/No Page 1 of 2 / 1 Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In -the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refeis to the site location on the attached checklist. DATE: TIME:* TIME: COMPETENT PERSON: RO?T •_<c:ALLoc.c_ Mri (Sicinature' LOCATION IN EXCAVATION WHERE-SAMPLE WAS TAKEN: Z -r5t1 2-f-fl1 71#cF TMt /i&, VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive)-_X_ COARSE GRAINED (Sand/Gravel):____ WATER CONDITIONS: WET DRY_ SURFACE WATER PRESENT ..L. SUBMERGED_ PREVIOUSLY DISTURBED SOIL31No LAYERED SOILS? Ye) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TOVIBRATIONSNo IF YES, DESCRIBE: iJk?Fl(_ CRACK-LIKE OPENINGS OR SPAWN SPALLINQ OBSERVED? Ye_;9 CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YeIF YES, DESCRIBE: SURFACE ENCUMBRANCES?&eNo IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? No POSSIBLE CONFINED SPACE EXPOSURE? Ye3 If YES, is company program in effect? Yes/No Page 1 of 2 / Sample Form to be used for Documentation Purposes to show Cal/OSHA - SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) ••, This checklist should be completed when soil analysis .is made to determine the soil type(s) present In the excavation. A separate analysis 'must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance, where soil type may change. The following information refers to the site location on the attached checklist. DATE: )(t V1V1', TIME: COMPErEWI PERSON: WO5eT. -(PiL.oc %o jiJ (Signature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ ee . VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive).-_XL COARSE GRAINED '(Sand/Gravel):___ WATER CONDITIONS: WET!! DRY_ SURFACE WATER PRESENT ..L.. SUBMERGED_ PREVIOUSLY DISTURBED SOILNo . LAYERED SOILS? Ye-4& LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONSZ,No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? YejIF YES, DESCRIBE: SURFACE ENCUMBRANCES Ye No IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?lNo POSSIBLE CONFINED SPACE EXPOSURE? Ye If YES, is company program in effect? Yes/No Page 1 of 2 I Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In :the excavation. A separate analysis must be peiformed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. DATE: TIME: CCMPErENTPERSON: _OR1 in* . [6 LOCATION. IN EXCAVATION WHERE SAMPLE WAS TAKEN: 14.9 VISUALTEST PARTICLE TYPE: FINE GRAINED (Cohesive)._)_(_ COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET DRY_ SURFACE WATER PRESENT_ SUBMERGED_ PREVIOUSLY DISTURBED SOIL4o LAYERED SOILS? Yes) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATIONS()No IF YES, DESCRIBE: Ti!IPPl(., CRACK-LIKE OPENINGS OR SPA WNG OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Yej)IF YES, DESCRIBE: SURFACE ENCUMBRANCES So IF YES, DESCRIBE: Fcfc P6pL-r WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC(A'No POSSIBLE CONFINED SPACE EXPOSURE? Yef YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM• (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) it excavation is stretched over a distance where soil type may change. The following information refers to the site location on the attached checklist. bATE:ol)zc ))qlz. TIME: _'7W COMPETENT PERSON: _ CHL40kZ_. signa el LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive) :X COARSE GRAINED (Sand/Gravel): WATER CONDITIONS: WET DRY_ SURFACE WATER PRESENT_ SUBMERGED_ PREVIOUSLY DISTURBED SOILlj1sJo LAYERED SOILS? Yes) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VIBRATlONS?'No IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPAWNG OBSERVED? Ye CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye) IF YES, DESCRIBE: SURFACE ENCUMBRANCESfco IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC-('4o POSSIBLE CONFINED SPACE EXPOSURE? YeIf YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM• (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In .the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: O//21...//" TIME: _7: 22 Cp9 1PERSON LO.Q i- (Signature) LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN: AN- VISUAL _TEST PARTICLE TYPE: FINE GRAINED (Cohesive).--X COARSE GRAINED (Sand/Gravel): pc WATER CONDITIONS: WET& DRY_ SURFACE WATER PRESENT........ SUBMERGED_ PREVIOUSLY DISTURBED SOlLJo LAYERED SOILS? Ye LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VlBRATIONSNo IF YES, DESCRIBE: CRACK-LIKE OPENINGS OR SPAWN SPALLINQ OBSERVED? Yelo CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE460 IF YES, DESCRIBE: SURFACE ENCUMBRANCES?'o IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC. 3No POSSIBLE CONFINED SPACE EXPOSURE? YeIf YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist. DATE: 01)21 TIME: 7aO COMPErEPff PERSON: fY4LL4A (PM) I Ill re) - LOCATION IN EXCAVATION WHERE SAMPLE WAS T VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive). _X_ COARSE GRAINED (Sand/Gravel): WATER CONDITIONS: WETL DRY_ SURFACE WATER PRESENT_ SUBMERGED_. PREVIOUSLY DISTURBED SOIL eo LAYERED SOILS? Yes) LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO VlBRATlON(fo IF YES, DESCRIBE: 7,1)PFK. CRACK-LIKE OPENINGS OR SPAWN SPALLINQ OBSERVED? Yese CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye3) IF YES, DESCRIBE: SURFACE ENCUMBRANCES!/NO IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC? POSSIBLE CONFINED SPACE EXPOSURE? Yesj)If YES, is company program in effect? Yes/No Page 1 of 2 Sample Form to be used for Documentation Purposes to show Cal/OSHA SOIL ANALYSIS FORM (To be Completed Daily by Competent Person) This checklist should be completed when soil analysis is made to determine the soil type(s) present In the excavation. A separate analysis must be performed: (1) on each layer of soil in excavation walls and (2) if excavation is stretched over a distance where soil type may change. The following Information refers to the site location on the attached checklist; DATE: _O(I1o/I1Z TIME: '731_COMPETENTPERSON:_f't 13 SCMILLOCk LOCATION IN EXCAVATION WHERE SAMPLE WAS TAKEN:_ ,41,4Sigñatür ZY e VISUAL TEST PARTICLE TYPE: FINE GRAINED (Cohesive): >< COARSE GRAINED (Sand/Gravel):___ WATER CONDITIONS: WET,. DRY_ SURFACE WATER PRESENT_ SUBMERGED_ PREVIOUSLY DISTURBED SOILNo LAYERED SOILS? Ye00 LAYERED SOIL DIPPING INTO EXCAVATION? Yes/No EXCAVATION EXPOSED TO. VIBRATIONS 3fN0 IFYES,DESCRIBE: 7F' CRACK-LIKE OPENINGS OR SPALLING OBSERVED? Y64) CONDITIONS THAT MAY CREATE A HAZARDOUS ATMOSPHERE? Ye)F YES, DESCRIBE: SURFACE ENCUMBRANCES Jo IF YES, DESCRIBE: WORK TO BE PERFORMED NEAR PUBLIC VEHICULAR TRAFFIC?Jo POSSIBLE CONFINED SPACE EXPOSURE? Yesf YES, is company program in effect? Yes/No Page 1 of 2