FA-1015_19070_CA_MRP_20140909

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

September 9, 2014

Mr. James Brown
North Carolina Department of Environment & Natural Resources
Division of Waste Management, UST Section
225 Green Street, Suite 714
Fayetteville, North Carolina 28301

Re: RECOVERY WELL INSTALLATION AND FREE PRODUCT RECOVERY REPORT
FOOD LION DISTRIBUTION CENTER #4
NC HIGHWAY 301 AND STATE ROAD 1780
DUNN, NORTH CAROLINA

Dear Mr. Brown:

AMEC Environment & Infrastructure, Inc. (AMEC) is pleased to present this copy of the Free
Product Recovery Report for the Food Lion Distribution Center #4 located in Dunn, North
Carolina. This report provides the results of the aggressive fluid vapor recovery conducted July
28-30, 2014, as well as a recommendation that AFVR be continued at the site.

If you have any questions or comments in regard to this report, please do not hesitate to contact
me at [phone] or [e-mail].

Sincerely,
AMEC Environment & Infrastructure, Inc.

Michael P. McKenna
Project Geoscientist

Attachment

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180

TABLE OF CONTENTS

1.0 SITE HISTORY AND CHARACTERIZATION ................................................................... 1
2.0 AGGRESSIVE FLUID VAPOR RECOVERY ..................................................................... 2
3.0 CONCLUSIONS AND RECOMMENDATIONS ................................................................. 3

FIGURES

Figure 1 Site Location Map
Figure 2 Site Layout
Figure 3 Groundwater Potentiometric Surface
Figure 4 Free Product Thickness

TABLES

Table B-7 Monitoring and Remediation Well Construction Information
Table B-8A Free Product Recovery Information
Table B-8B Cumulative Volume of Free Product Recovered from Site
Table B-9 Current and Historical Groundwater Elevations, and Free Product Thickness

APPENDICES

Appendix A Site Health and Safety Plan
Appendix B Aggressive Free Vapor Recovery Vacuum Logs
Appendix C Investigation-Derived Waste Disposal Documentation

AMEC Environment & Infrastructure, Inc. Page 1 Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180

1.0 SITE HISTORY AND CHARACTERIZATION

Site Description and Background

The Food Lion Distribution Center #4 (site) is located at 2940 Arrowhead Road in Dunn, Harnett
County, North Carolina (Figure 1). The site is owned by Delhaize America, a parent company to
Food Lion, Inc. (Food Lion). The site is currently utilized as a product distribution center for
Food Lion. As such, Food Lion provides a fueling station to allow distribution trucks to refuel.
Historically, the site stored diesel fuel in two 25,000-gallon (gal) underground storage tanks
(USTs) for truck refueling. The site currently consists of the distribution center/warehouse, the
truck maintenance facility, refueling station and parking lots.

The site is classified as intermediate risk. A receptor survey conducted in 2000 confirmed there
were five water-supply wells within 1,500 feet of the site, located hydraulically upgradient of the
source area, and that municipal water is available to these properties. The site is located in a
rural area consisting of properties used for both residential and commercial purposes.

Several site characterization and assessment activities have been performed at the site to
identify the extent of soil and groundwater impacts attributed to the two 25,000-gal USTs
formerly located on the subject property. Based on these investigations, soil and groundwater
were determined to be impacted by the two diesel USTs and associated product piping. Free
product was observed at the site during assessment activities in March 1997 and subsequently,
four recovery wells were installed in May 1998. Four aggressive fluid vapor recovery (AFVR)
events were performed in the summer of 1998 to remove free product from the recovery wells.
Ultimately, the two 25,000-gal USTs were removed in September 1998 and replaced with
aboveground storage tanks (ASTs). Following the UST removal activities, a Limited Site
Assessment (February 1999) and Corrective Action Plan (CAP; June 2000) were prepared. The
proposed remedial alternative presented free product removal followed by monitored natural
attenuation (MNA) for the impacted groundwater beneath the site. Following submittal of the
CAP, a pneumatic pump free product recovery system was installed. Records regarding the
length of time the system operated or how much product was removed have not been located
by the facility; however, Mr. Mark Davis (facility representative) believes it was shut down in
2007.

On July 8, 2010, the North Carolina Department of Environment and Natural Resources
(NCDENR), Division of Waste Management (DWM), UST Section issued a Notice of Regulatory
Requirement (NORR) requesting that a Free Product Evaluation and Free Product Recovery
Report be submitted. In August 2010, the free product was re-evaluated and the recovery well
system was restarted. The recovery well system became inoperable and the free product
recovery utilizing the recovery well system ceased.

In August 2012, Food Lion retained AMEC Environment & Infrastructure, Inc. (AMEC) to
conduct additional free product assessment at the site, submit a Free Product Recovery System
Specification Report to NCDENR, DWM, UST Section, and to implement an approved Free
Product Recovery Plan in response to the NORR received on May 31, 2011. To assess the free
product at the site, AMEC subcontracted Regional Probing Services, located in Youngsville,
North Carolina, to provide GeoProbe™ services in tandem with Laser Induced Fluorescence/
Recovery Well Installation and Free Product Recovery Report
Food Lion Distribution Center #4
Dunn, North Carolina
September 9, 2014

AMEC Environment & Infrastructure, Inc. Page 2 Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180
Ultraviolet Optical Screening Tool (LIF/UVOST) technology. The LIF/UVOST technology was
operated by Columbia Technologies, LLC of Baltimore, Maryland. Field activities were
conducted in December 2012, and the Free Product Recovery System Specification Report was
submitted on April 5, 2013. The report detailed the successful delineation of free product on the
site using LIF/UVOST, and recommended the installation of five supplementary recovery wells
and multiple additional AFVR events to remove the remaining free product.

Costs of recovery well installation and a well survey were authorized in Task Authorization
1970-5, dated June 12, 2013. The first two AFVR events were approved in Task Authorization
1970-6, dated August 22, 2013. The recovery wells were installed on July 9, 2013, and
construction details of the monitoring and recovery wells are provided in Table B-7. The first
AFVR event was conducted September 9-11, 2013, and the second AFVR event was
conducted January 15-17, 2014. The third and fourth AFVR events were authorized in Task
Authorization 1970-7, dated April 22, 2014. The third event was conducted April 23-25, 2014,
and details of the fourth AFVR event are presented herein. The Health and Safety Plan is
provided in Appendix A.

2.0 AGGRESSIVE FLUID VAPOR RECOVERY

The Fourth AFVR event was performed over a three-day period, July 28 to July 30, 2014, and
all nine recovery wells (RW-1 through RW-9) were included. The AFVR event was supervised
by AMEC personnel and performed by FCC Environmental of Concord, North Carolina (FCC
Environmental). The AFVR was conducted by connecting three recovery wells per day to a
manifold, which was then connected to a vacuum truck and subjected to vacuum for eight
hours. FCC Environmental personnel recorded the vacuum at each well head on a half-hourly
basis. The vacuum logs are provided in Appendix B and the site layout is presented in Figure 2.

Prior to the AFVR event, the monitoring and recovery wells were gauged for depth-to-water and
free product thickness. According to the groundwater elevations, groundwater flow across the
site is to the west. A groundwater potentiometric surface map is provided in Figure 3 and a
depiction of free product thickness, measured in each well prior to performing the AFVR event,
is detailed in Figure 4.

Free product was present on the surface of the groundwater in six of the nine recovery wells, at
thicknesses ranging from 0.10 to 1.60 feet. Free product was not present on the surface of
groundwater in recovery wells RW-1, RW-5 and RW-7 (see Table B-8A). After the AFVR event,
the recovery wells were again gauged for free product thickness; free product remaining after
AFVR ranged from 0.00 feet to 0.13 feet.

In total, 13,039 gallons of fluid were removed from the nine recovery wells (approximately 131
gallons were free product), as measured in the vacuum truck after the AFVR event. The balance
of the fluid was a mixture of water and free product that had not yet separated. The previous
three AFVR events recovered 192, 190, and 179 gallons of free product, respectively. Four
AFVR events conducted in 1998 recovered 326, 524, 523 and 326 gallons of free product,
respectively (see Table B-8B). The smaller volume of free product recovered during successive
AFVR events is likely the result of the effectiveness of the previous AFVR events and the former
Recovery Well Installation and Free Product Recovery Report
Food Lion Distribution Center #4
Dunn, North Carolina
September 9, 2014

AMEC Environment & Infrastructure, Inc. Page 3 Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180
free product recovery system. Liquid recovered was transported and disposed by FCC
Environmental, and waste manifests are provided in Appendix C.

3.0 CONCLUSIONS AND RECOMMENDATIONS

Although the amount of free product present in the wells has decreased as a result of previous
recovery activities, the December 2012 LIF/UVOST free product delineation revealed that
between one and two feet of free product existed in the vadose and saturated zones in all
locations in which the supplementary recovery wells were installed. As the recovery wells were
installed such that the screened interval straddles the top of groundwater, AFVR is an effective
means of removing not only the free product that is detected on the surface of groundwater, but
also from the vadose zone surrounding these wells.

Multiple AFVR events have been performed at Food Lion and AFVR has proven to be an
effective treatment method at the site. Approximately 2,391 gallons of free product have been
removed to date using AFVR, demonstrating that this method effectively targets free product
and reduces impacts to groundwater. Historical free product measurements from recovery wells
indicate an overall reduction in thickness (see Table B-9). Free product measurements
conducted at the beginning of the fourth AFVR event revealed that free product remained in
only six of the nine recovery wells.

AFVR remains an economical and readily implementable technology for removal of free
product, with the benefit of low O&M costs. AMEC recommends continuation of quarterly AFVR
events for another four quarters. However, AMEC recommends that the number of wells
included in the AFVR events be reduced from nine to six, to include only recovery wells RW-2,
RW-3, RW-4, RW-6, RW-8, and RW-9. Recovery wells RW-1, RW-5, and RW-7, which were not
found to contain free product in the fourth event, would be excluded from the next four events.

AMEC evaluated the viability of mobile multi-phase extraction (MMPE) at the site. Based on
contractor estimates, it did not appear that a switch to MMPE would cost less than AFVR.
Additionally, the free product recovery occurs in a medium traffic area of a 24-hour facility. As
such, it is important that personnel are onsite during the entirety of each event to respond
immediately to traffic incidents or unforeseen client needs that necessitate moving AFVR
equipment. Because of this, AMEC determined that AFVR is the more appropriate free product
recovery method for this site.

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180
FIGURES
^_Copyright:© 2013 National Geographic Society, i-cubedFigureDR:CHK:DATE:SITE LOCATION MAP1A. Crain H. Thurston12/30/2013CLIENT:PROJ.:6470133028TITLE:SCALE:SITE:AMEC Environment & Infrastructure, Inc.4021 Stirrup Creek Drive, Suite 100Durham, NC 27703(919) 381-9900LOCATION:\\dhm-fs1\projects\Comm-Ind\Projects\Clients A to F\Food Lion\2013\GIS\AFVR 1st EventFOOD LION, INC.02,4001,200FeetLegend^_Site Location³FOOD LION DISTRIBUTION CENTER #42940 Arrowhead Road, Dunn, North Carolina1 " = 1,200 '
!(#7!(#7!(#7"D#7#7#7#7#7#7RW-9RW-8RW-7RW-6RW-5RW-4MW-4RW-3MW-3RW-2MW-2RW-1MW-1Existing ASTsFormer Location of USTsProduct PipelinePump IslandsExisting Treatment SystemUS 301 SNC OneMapFigureDR:CHK:DATE:SITE LAYOUT2A. Crain H. Thurston12/30/2013CLIENT:PROJ.:6470133028TITLE:SCALE:SITE:AMEC Environment & Infrastructure, Inc.4021 Stirrup Creek Drive, Suite 100Durham, NC 27703(919) 381-9900LOCATION:\\dhm-fs1\projects\Comm-Ind\Projects\Clients A to F\Food Lion\2013\GIS\AFVR 1st EventFOOD LION, INC.08040FeetLegend!(Shallow Monitoring Well "DDeep Monitoring Well#7Recovery WellRoadwaysHarnett County Parcels³FOOD LION DISTRIBUTION CENTER #42940 Arrowhead Road, Dunn, North Carolina1 " = 40 '
!(#7!(#7!(#7"D#7#7#7#7#7#7Existing ASTsFormer Location of USTsProduct PipelinePump IslandsExisting Treatment SystemMW-4NM166.50'167.00'167.50'168.00'168.50'US 301 SRW-9167.07RW-8167.05RW-7166.77RW-6166.60RW-5166.25RW-4166.61RW-3167.46MW-3168.59RW-2166.96MW-2166.83RW-1166.13MW-1166.04NC OneMapFigureDR:CHK:DATE:GROUNDWATER POTENTIOMETRIC MAPJULY 20143A. Crain H. Thurston08/28/2014CLIENT:PROJ.:6470133028TITLE:SCALE:SITE:AMEC Environment & Infrastructure, Inc.4021 Stirrup Creek Drive, Suite 100Durham, NC 27703(919) 381-9900LOCATION:\\dhm-fs1\projects\Comm-Ind\Projects\Clients A to F\Food Lion\2013\GIS\AFVR 1st EventFOOD LION, INC.08040FeetLegend!(Shallow Monitoring Well "DDeep Monitoring Well#7Recovery WellFlow DirectionGroundwater ContourInferred Groundwater ContourRoadwaysHarnett County Parcels³FOOD LION DISTRIBUTION CENTER #42940 Arrowhead Road, Dunn, North Carolina1 " = 40 'Notes:166.70' = Groundwater elevation in feetNM = Not measured
!(#7!(#7!(#7"D#7#7#7#7#7#7Existing ASTsFormer Location of USTsProduct PipelinePump IslandsExisting Treatment SystemUS 301 SMW-4NMRW-70RW-50MW-30MW-20RW-10MW-10RW-90.10RW-80.30RW-60.66RW-41.60RW-30.39RW-20.39NC OneMapFigureDR:CHK:DATE:FREE PRODUCT THICKNESSJULY 20144A. Crain H. Thurston08/28/2014CLIENT:PROJ.:6470133028TITLE:SCALE:SITE:AMEC Environment & Infrastructure, Inc.4021 Stirrup Creek Drive, Suite 100Durham, NC 27703(919) 381-9900LOCATION:\\dhm-fs1\projects\Comm-Ind\Projects\Clients A to F\Food Lion\2013\GIS\AFVR 1st EventFOOD LION, INC.08040FeetLegend!(Shallow Monitoring Well "DDeep Monitoring Well#7Recovery WellRoadwaysHarnett County Parcels³FOOD LION DISTRIBUTION CENTER #42940 Arrowhead Road, Dunn, North Carolina1 " = 40 'Notes:Values inBLUErepresent free product thickness in feet.Free product thickness in recovery wells measured July 28, 2014NM = Not measured

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180
TABLES
Table B-7Monitoring and Remediation Well Construction InformationFood Lion Distribution Center #4Dunn, North CarolinaWell IDDate InstalledDate Water Level MeasuredWell Casing Diameter (in)Well Casing Depth (ft BGS)Screened Interval (ft BGS)Depth of Well (ft BGS)Top of Casing Elevation* (ft)Depth to Water from Top of Casing (ft)Free Product Thickness in Soil from 2012 LIF (ft)Initial Free Product Thickness in Well (ft)Groundwater Elevation** (ft)Location Northing*Location Easting*MW-1 11/17/98 07/28/14 2 15 5-15 15 170.22 4.18 NM 0 166.04 555522.75 2110041.08MW-2 11/17/98 07/28/14 2 15 5-15 15 172.88 6.05 NM 0 166.83 555306.26 2110091.14MW-3 11/17/98 07/28/14 2 15 5-15 15 172.72 4.13 NM 0 168.59 555570.96 2110496.71MW-4 11/17/98 07/28/14 2 50 40-50 50 173.80 NM ~2.2 0 NM 555475.34 2110282.35RW-1 11/11/98 07/28/14 4 13.5 3.5-13.5 13.5 172.28 6.15 NM 0 166.13 555514.18 2110151.53RW-2 11/11/98 07/28/14 4 14.5 4.5-14.5 14.5 173.53 6.90 ~2.20.39 166.96 555471.42 2110281.62RW-3 11/11/98 07/28/14 4 14.5 4.5-14.5 14.5 173.44 6.31 ~1.40.39 167.46 555473.39 2110346.48RW-4 11/11/98 07/28/14 4 14 4-14 14 173.14 7.90 ~2.0 1.60 166.61 555485.91 2110222.20RW-5 07/09/13 07/28/14 4 13 3-13 13 173.06 6.81 ~1.5 0 166.25 555467.02 2110177.66RW-6 07/09/13 07/28/14 4 18 3-18 18 173.64 7.61 ~1.7 0.66 166.60 555449.25 2110220.85RW-7 07/09/13 07/28/14 4 18 3-18 18 173.52 6.75 ~2.0 0 166.77 555521.35 2110263.81RW-8 07/09/13 07/28/14 4 14 4-14 14 173.71 6.92 ~2.2 0.30 167.05 555505.03 2110307.87RW-9 07/09/13 07/28/14 4 14.5 4-14.5 14.5 173.38 4.89 ~2.1 0.10 168.58 555540.31 2110319.95Notes:ft BGS = feet below ground surfaceNM = not measured*Well locations and casing elevations from KCI survey of 7/26/2013, based on NC State Plane NAD '83 and NAVD '88** If free product is present in a well, groundwater elevation is calculated by: [Top of Casing Elevation - Depth to Water] + [free product thickness x 0.8581]LIF - Laser-induced fluorescence; thickness determined in the December 2012 event.
Table B-8AFree Product Recovery InformationFood Lion Distribution Center #4Dunn, North CarolinaDate Well IDProduct TypeFree Product Recovery MethodProduct Thickness Before Recovery (ft)Product Thickness After Recovery (ft)Amount of Liquid (Water + Product) (gallons)Amount of Liquid Product (gallons)Total Amount of Product Recovered (gallons)RW-70 0RW-80.30 0.01RW-90.10 0.02RW-20.39 0.21*RW-30.39 0.13*RW-41.60 0.17*RW-10 0RW-50 0RW-60.66 0Notes:AFVR = aggressive fluid vapor recovery* = Post-AFVR product thickness measured the follwing day3,80007/29/14 Diesel AFVR3,724 38 3,76207/28/14 Diesel AFVR3,762 3855 5,477Diesel AFVR5,42207/30/14
Table B-8BCumulative Volume of Free Product Recovered from SiteFood Lion Distribution Center #4Dunn, North CarolinaDate of Recovery EventTotal Volume Recovered from Site During Current Recovery Event (gallons)Cumulative Total of Volume Recovered to Date from All Recovery Events (gallons)05/08/9832632606/12/9852485007/06/985231,37307/22/983261,69909/09/13 - 09/11/13 1921,89101/15/14 - 01/17/14 1902,08104/23/14 - 04/25/14 1792,26007/28/14-07/30-14 1312,391
Table B-9Current and Historical Groundwater Elevations and Free Product Thickness Food Lion Distribution Center #4Dunn, North CarolinaWell IDDate MeasuredScreened Interval (top of screen, bottom of screen)Top of Casing Elevation* (ft)Depth to Water Uncorrected (ft)Depth to Free Product (ft)Free Product Thickness (ft)Depth to Water Corrected for Free Product Thickness**(ft)Top of Casing Elevation (MSL)Groundwater Surface Elevation*** (MSL)11/17/98 5-15 170.22 5.58 NA 0 5.58 170.22 164.6410/19/10 5-15 170.224.08NA 0 4.08 170.22 166.1409/09/13 5-15 170.224.02NA 0 4.02 170.22 166.2001/15/14 5-15 170.223.74NA 0 3.74 170.22 166.4807/28/14 5-15 170.223.90NA 0 3.90 170.22 166.3204/23/14 5-15 170.224.18NA 0 4.18 170.22 166.0411/17/98 5-15 172.88 7.73 NA 0 7.73 172.88 165.1510/19/10 5-15 172.886.76NA 0 6.76 172.88 166.1212/07/12 5-15 172.888.35NA 0 8.35 172.88 164.5309/09/13 5-15 172.88 6.76 NA 0 6.76 172.88 166.1201/15/14 5-15 172.88 6.19 NA 0 6.19 172.88 166.6904/23/14 5-15 172.88 5.93 NA 0 5.93 172.88 166.9507/28/14 5-15 172.88 6.05 NA 0 6.05 172.88 166.8311/18/98 5-15 172.72 6.47 NA 0 6.47 172.72 166.2510/19/10 5-15 172.724.00NA 0 4.00 172.72 168.7212/07/12 5-15 172.727.16NA 0 7.16 172.72 165.5609/09/13 5-15 172.72 3.63 NA 0 3.63 172.72 169.0901/15/14 5-15 172.72 1.13 NA 0 1.13 172.72 171.5904/23/14 5-15 172.72 1.63 NA 0 1.63 172.72 171.0907/28/14 5-15 172.72 4.13 NA 0 4.13 172.72 168.5911/19/98 45-50 173.80 28.91 NA 0 28.91 173.80 144.8910/19/10 45-50 173.80 10.81 NA 0 10.81 173.80 162.9909/09/13 45-50 173.8011.97NA 0 11.97 173.80 161.8301/15/14 45-50 173.80NMNM NM NA 173.80 NA04/23/14 45-50 173.80NMNM NM NA 173.80 NA07/28/14 45-50 173.80NMNM NM NA 173.80 NA11/11/98 3.5-13.5 172.28 7.75 6.950.807.06 172.28 165.2210/19/10 3.5-13.5 172.28 6.805.95 0.856.07 172.28 166.2112/03/12 3.5-13.5 172.28 7.196.80 0.396.86 172.28 165.4209/09/13 3.5-13.5 172.28 6.31 5.460.855.58 172.28 166.7001/15/14 3.5-13.5 172.28 6.13 5.810.325.86 172.28 166.4204/23/14 3.5-13.5 172.28 5.95 5.810.145.83 172.28 166.4507/28/14 3.5-13.5 172.28 6.15 NA0.006.15 172.28 166.1311/11/98 4.5-14.5 173.53 11.65 8.103.558.60 173.53 164.9310/19/10 4.5-14.5 173.538.156.15 2.006.43 173.53 167.1012/03/12 4.5-14.5 173.5310.358.02 2.338.35 173.53 165.1809/09/13 4.5-14.5 173.53 8.12 6.112.016.40 173.53 167.1301/15/14 4.5-14.5 173.53 5.69 5.000.695.10 173.53 168.4304/23/14 4.5-14.5 173.53 5.72 5.170.555.25 173.53 168.2807/28/14 4.5-14.5 173.53 6.90 6.510.396.57 173.53 166.96RW-2MW-1MW-2MW-3MW-4RW-1
Table B-9Current and Historical Groundwater Elevations and Free Product Thickness Food Lion Distribution Center #4Dunn, North CarolinaWell IDDate MeasuredScreened Interval (top of screen, bottom of screen)Top of Casing Elevation* (ft)Depth to Water Uncorrected (ft)Depth to Free Product (ft)Free Product Thickness (ft)Depth to Water Corrected for Free Product Thickness**(ft)Top of Casing Elevation (MSL)Groundwater Surface Elevation*** (MSL)11/11/98 4.5-14.5 173.44 10.70 7.952.758.34 173.44 165.1010/19/10 4.5-14.5 173.447.655.39 2.265.71 173.44 167.7312/03/12 4.5-14.5 173.449.937.64 2.297.96 173.44 165.4809/09/13 4.5-14.5 173.44 7.55 5.362.195.67 173.44 167.7701/15/14 4.5-14.5 173.44 3.97 3.470.503.54 173.44 169.9004/23/14 4.5-14.5 173.44 4.70 4.090.614.18 173.44 169.2607/28/14 4.5-14.5 173.44 6.31 5.920.395.98 173.44 167.4611/11/98 4-14 173.14 11.00 7.653.358.13 173.14 165.0110/19/10 4-14 173.148.655.85 2.806.25 173.14 166.8912/03/12 4-14 173.1410.007.50 2.507.85 173.14 165.2909/09/13 4-14 173.148.405.86 2.546.22 173.14 166.9201/15/14 4-14 173.145.715.12 0.595.20 173.14 167.9404/23/14 4-14 173.146.045.31 0.735.41 173.14 167.7307/28/14 4-14 173.147.906.30 1.606.53 173.14 166.6109/09/13 3-13 173.066.57NA 06.57 173.06 166.4901/15/14 3-13 173.066.00NA 06.00 173.06 167.0604/23/14 3-13 173.066.09NA 06.09 173.06 166.9707/28/14 3-13 173.066.81NA 06.81 173.06 166.2509/09/13 3-18 173.648.396.57 1.826.83 173.64 166.8101/15/14 3-18 173.647.085.73 1.355.92 173.64 167.7204/23/14 3-18 173.646.316.05 0.266.09 173.64 167.5507/28/14 3-18 173.647.616.95 0.667.04 173.64 166.6009/09/13 3-18 173.526.50NA 06.50 173.52 167.0201/15/14 3-18 173.525.49NA 05.49 173.52 168.0304/23/14 3-18 173.525.62NA 05.62 173.52 167.9007/28/14 3-18 173.526.75NA06.75 173.52 166.7709/09/13 4-14 173.716.816.27 0.546.35 173.71 167.3601/15/14 4-14 173.715.215.00 0.215.03 173.71 168.6804/23/14 4-14 173.715.265.21 0.055.22 173.71 168.4907/28/14 4-14 173.716.926.62 0.306.66 173.71 167.0509/09/13 4-14.5 173.38 6.78 6.510.276.55 173.38 166.8301/15/14 4-14.5 173.38 5.59 5.560.035.56 173.38 167.8204/23/14 4-14.5 173.38 4.89 4.800.094.81 173.38 168.5707/28/14 4-14.5 173.38 6.40 6.300.106.31 173.38 167.07Notes:*Well locations and casing elevations from KCI survey of 7/26/2013, based on NC State Plane NAD '83 and NAVD '88** If free product is present in a well, corrected depth to water is calculated by: [Depth to Water] - [free product thickness x 0.8581]***Groundwater surface elevation is calculated using corrected depths to waterNA = Not ApplicableNM = Not MeasuredRW-3RW-4RW-5RW-6RW-7RW-8RW-9

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180
APPENDIX A

HEALTH AND SAFETY PLAN

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

AMEC Environment & Infrastructure, Inc.
Health & Safety Plan

Well Installation and Dual-Phase Extraction
Food Lion Distribution Center #4 Property
Harnett County, Dunn, North Carolina

Prepared For:

Food Lion, Inc.
2940 Arrowhead Road
Dunn, NC 28334

Prepared By:

AMEC Environment & Infrastructure, Inc.
4021 Stirrup Creek Drive, Suite 100
Durham, North Carolina 27703

AMEC Project No.: 6470133028

July 2013

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

Petroleum Free Product Assessment and Recovery Activities
Food Lion Distribution Center #4 Property
Harnett County, Dunn, North Carolina

This Site-Specific Health and Safety Plan (HSP) has been developed by AMEC Environment &
Infrastructure, Inc. (AMEC) to comply with requirements under OSHA 29 CFR 1910 and 1926.
This HSP may require periodic updates, as appropriate, if new work tasks are required, or if site
conditions/ potential hazards change from those outlined herein.

REVIEW AND APPROVALS
Reviewed and Certified by:

7/8/13
Susan Johnson Date
Department Manager

Prepared by:

7/5/13
Michael McKenna Date
HSE Coordinator

Approved by:

7/8/13
Harold Thurston Date
Senior Project Manager

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

HSP EMERGENCY SUMMARY SHEET

The Site Health and Safety Coordinator (SHSC), the Project Manager (PM), the Raleigh Office
HSE Coordinator, and Corporate Health and Safety Director (CHSD) shall be notified
immediately if worker exposure, accidents, or site conditions not anticipated in this document
are encountered.
RESPONDING EMERGENCY AGENCIES
Service Telephone Number
Ambulance 911
Fire Department 911
Police Department 911

PROJECT EMERGENCY CALL LIST
Title Name Telephone Number
Project Manager (PM) Harold Thurston [phone] (office)
[phone] (cell)
Field Manager (FM)/SHSC Anthony Kellogg [phone] (cell)
CHSD Vladimir Ivensky, CIH, CSP [phone] (office)
HSE Coordinator Michael McKenna [phone] (office)
[phone] (cell)
Client Mark Davis [phone]
* In the event of an occupational accident or incident, please indicate to the medical facility that this is a
Workers’ Compensation case; that your employer is AMEC; and that the insurance administrator is AIG
Claims. Subcontractors will provide internal Workers’ Comp. policy information; this may be provided to
the SHSC at the prework meeting.

EMERGENCY TELEPHONE NUMBER LIST
Organization Telephone Number
OSHA – North Carolina Office [phone] – Allen McNeely, Director
National Response Center [phone]
EPA Environmental Response Team – Region IV [phone]
Poison Control [phone]
WorkCare 24/7 Hotline (Must Call Within 1 Hour) [phone]

Nearest Phone: Carry cellular phone.
Nearest Water: Carry water.

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

POTENTIAL PHYSICAL HAZARDS: including but not limited by back injuries, cold/heat stress,
discharge of static electricity, drill rigs and heavy equipment operation, heavy equipment and
vehicle, entanglement, ergonomic stress, inclement weather and shut-down condition, noise,
slips, trips, and falls, and UV exposure.

POTENTIAL CHEMICAL HAZARDS: Lead and petroleum related constituents of concern
(COCs) such as 1,2,4-trimethylbenzene, 1,3,5-trimethylbenzene, benzene, ethylbenzene,
isopropyl ether, isopropyl benzene, methyl tert-butyl ether, n-butylbenzene, n-propylbenzene,
naphthalene, total xylenes, sec-butylbenzene and toluene.

CHEMICAL MATERIALS HANDLED AT THE SITE: Liquinox detergent and Calibration gases
(e.g., isobutylene).

RECOMMENDED AIR MONITORING EQUIPMENT: Photoionization Detector (PID)

REQUIRED PERSONAL PROTECTIVE EQUIPMENT AND AIR MONITORING EQUIPMENT:
Modified Level D and PID.

ACTION LEVELS AND ACTION
EQUIPMENT/
CONTAMINANTS ACTION LEVEL ACTION TO BE TAKEN
PID/Petroleum
Related COCs, Lead
<10 ppm-equivalents above back-
ground in the breathing zone (BZ). Maintain Level D or Mod. D.
>10 ppm-equivalent above
background in the BZ Upgrade to Level C PPE.
>10 ppm-equivalent above
background on the site perimeter
Cease operations until levels fall to
within background readings, and/or
investigation area is ruled out as source
of elevated reading.

HOSPITAL INFORMATION (for Map/Directions see next page)
IN CASE OF LIFE THREATENING INJURIES, CALL 911
USE AMBULANCE TO CLOSEST TRAUMA CENTER

NOTE: In case of any hazard exposure during and/or prior to medical attention, the
hospital and any emergency response personnel shall be notified that patient and/or the
patient’s clothing may be contaminated.

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com
Hospital Directions:
HOSPITAL NAME: HOSPITAL ADDRESS:
Betsy Johnson Regional
Hospital (3.1 miles)
800 Tilghman Drive
Dunn, NC 28335
HOSPITAL TELEPHONE: DIRECTIONS:
[phone] 1. Head northwest on Arrowhead Rd toward Bears Ln
2. Take the 2nd right onto Chicken Farm Rd
3. Turn left onto Susan Tart Rd
4. Turn right, destination will be on the RIGHT.

Hospital Route Map:

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

TABLE OF CONTENTS

1.0 INTRODUCTION ............................................................................................................. 1

1.1 GENERAL INFORMATION/ SCOPE OF WORK ............................................................. 1
1.2 SCHEDULED ONSITE PERSONNEL:* ......................................................................... 2
1.3 PERSONNEL RESPONSIBILITIES .............................................................................. 2

2.0 PERSONNEL PROTECTION .......................................................................................... 3

3.0 SITE CHARACTERIZATION ........................................................................................... 3

4.0 EMERGENCY REFERENCE LIST ................................................................................ 12

5.0 HEALTH AND SAFETY PLAN ACCEPTANCE ............................................................ 14

LIST OF TABLES

TABLE 1 Site Characterization .................................................................................................. 3
TABLE 2 Summary of Physical and Operational Safety Hazards .............................................. 5
TABLE 3 Chemical Hazard Information ................................................................................... 11

LIST OF APPENDICES and FIGURES

APPENDIX 1 Site Location
APPENDIX 2 Site Forms

LIST OF ACRONYMS AND ABBREVIATIONS

CIH Certified Industrial Hygienist
CFR Code of Federal Regulations
CHSD Corporate Health and Safety Director
CPR Cardio Pulmonary Resuscitation
COC Constituents of Concern
COPC Chemicals of Possible Concern
CRZ Contamination Reduction Zone
dBA Decibels A-Weighted
EC Emergency Coordinator
EPA Environmental Protection Agency
EZ Exclusion Zone
FT Feet
GW Groundwater

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

LIST OF ACRONYMS AND ABBREVIATIONS

HAZWOPER Hazardous Waste Operations Emergency Response
HBV Hepatitis B Virus
HIV Human Immunodeficiency Virus
HSM Health and Safety Manager
HSP Health and Safety Plan
lbs Pounds
IDLH Immediately Dangerous to Life and Health
mg/L Micrograms Per Liter
mph Miles Per Hour
MSDS Material Safety Data SHEETs
MW Monitoring Well
NCNG North Carolina Army National Guard
OSHA Occupational Safety and Health Administration
PID Photoionization Detector
PM Project Manager
PPE Personal Protective Equipment
ROC Record of Change
SC Safety Coordinator
SHSC Site Health and Safety Coordinator
SOP Standard Operating Procedures
SZ Support Zone
TPH Total Petroleum Hydrocarbons
TPH-DRO Total Petroleum Hydrocarbons Diesel Range Organics
TPH-GRO Total Petroleum Hydrocarbons Gasoline Range Organics
TWA Time-Weighted Average
US United States
UST Underground Storage Tank
VOC Volatile Organic Compounds

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com
1.0 INTRODUCTION

1.1 General Information/ Scope of Work

This site-specific Health and Safety Plan (HSP) has been prepared by AMEC Environment &
Infrastructure, Inc. (AMEC) exclusively for safety and health requirements related to petroleum free
product assessment and recovery activities at the Food Lion property at 2940 Arrowhead Road in
Dunn, North Carolina, hereafter referred to as the “Site”. This HSP presents the minimum
requirements for safety and health that must be met by AMEC and its subcontractors. All field and
contractor personnel shall read, understand, and comply with the requirements of this Site-Specific
HSP. All visitors shall also be required to review, sign, and comply with this approved Site-Specific
HSP and the HSP for Petroleum Impacted Sites to gain site entry.

It is the responsibility of individual subcontractors to implement an appropriate health
and safety program for their employees, including as appropriate:

• Compliance with 29 Code of Federal Regulation (CFR) 1910.120 Occupational
Safety and Health Administration (OSHA) guidelines regarding 40-hour
Hazardous Waste Operations Emergency Response (HAZWOPER) and/or 24-
hour Awareness training;
• Medical Monitoring, Medical Examination for Fitness to Work including
Respirator Use pursuant to 29 CFR 1910.134 OSHA Respiratory Protection
Standard, if required,
• Supplying Personal Protective Equipment (coveralls, respirators, boots, gloves,
etc.) as required by site conditions; and,
• Compliance with 29 CFR 1926 OSHA Construction Standard.

This HSP is provided as a guide only. Copies documenting the above training and
programs should be kept on-site by all subcontractors.

The HSP has been written to be consistent with all applicable federal, state, and local safety and
health requirements. Specific references consulted in assembling the HSP include:

• 29 CFR 1910 OSHA General Industry and 1926 OSHA Construction Standards
• AMEC HSE Program and field operating practices

Client:
Food Lion, Inc.

The Site is located at 2940 Arrowhead Road in Dunn, North Carolina (see site map in Appendix I).
Scope of work is as follows:

1) Installation of five recovery wells
2) Dual-phase extraction from nine recovery wells

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 2

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

COCs may include lead and petroleum related constituents such as 1,2,4-trimethylbenzene,
1,3,5-trimethylbenzene, benzene, ethylbenzene, isopropyl ether, isopropyl benzene, methyl tert-
butyl ether, n-butylbenzene, n-propylbenzene, naphthalene, total xylenes, sec-butylbenzene
and toluene.

1.2 Scheduled Onsite Personnel:*

NAME COMPANY PROJECT TITLE
Anthony Kellogg AMEC Task Manager/ Site Health and Safety Coordinator
SADACCO Well installation - driller and laborers
FCC Environmental DPE – vacuum truck driver and laborers
KCI, Inc Utility clearance – KCI personnel
KCI, Inc Well survey – KCI surveyors
* the Record of Change (ROC) form must reflect all personnel changes. All new personnel will be added
to the Onsite Personnel Record.

1.3 Personnel Responsibilities

Site Health and Safety Coordinator
Reports jointly to the AMEC Health and Safety Manager (HSM) and the Project Manager (PM)
for all aspects of the project and is the primary contact for health and safety during all field
activities, establishes work zones, evacuation routes, and assembly areas. The SHSC makes
the day-to-day decision to modify levels of protection provided in the Health and Safety Plan
(HSP) based on site conditions or monitoring data and has the authority to stop all work if
conditions are judged to be hazardous to onsite personnel or the public, and reports and
investigates accidents and near misses. Other specific responsibilities are detailed within
Section 3 of Volume II, Health and Safety Program for Site Investigations, of the AMEC
Corporate Health and Safety Manual.

The SHSC or designee must carefully document the implementation of this HSP by maintaining
the Project Health and Safety Files.

Field Staff selected as Safety Coordinators (SC) will be expected to immediately report any
accidents, near misses, and/or unsafe conditions to the SHSC or the PM. The SC will perform
daily tailgate safety meeting reports for remote sites and all documentation will be reviewed by
the SHSC on a regular basis.

Health and Safety Manager
The HSM is a Certified Industrial Hygienist (CIH) or Safety Professional with five or more years
of Occupational Safety and Health experience that is responsible for the review and approval of
the HSP and may help coordinate the implementation of health and safety procedures through
supervision/ direction of the SHSC. The HSM is approved by the Corporate Health and Safety
Director (CSHD). The HSM is responsible for approval of all changes made to this HSP.

Project or Field Manager/ Supervisor
Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 3

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com
The project manager (PM) has responsibility for all field activities, enforcement of safe work
practices, and ensuring that daily tailgate meetings are conducted, and serves as the
Emergency Coordinator (EC) in emergency situations. The PM assumes (or assigns to a
qualified person) the SHSC duties and responsibilities when the SHSC is not onsite.

Field Team Members
All AMEC and subcontracting personnel are responsible for compliance with this HSP in its
entirety. They are responsible for taking all reasonable precautions to prevent injury to
themselves and to their fellow employees and for being alert to potentially harmful situations.
Field team members are expected to perform only those tasks that they believe can be done
safely and to immediately report any accidents, near misses, and/or unsafe conditions to the
SHSC or the PM.

2.0 PERSONNEL PROTECTION

Please refer to the HSP for Petroleum Impacted Sites. This document will be maintained
on-site by the Site Health and Safety Coordinator.

Emergency Medical Treatment:
Personnel who exhibit signs and symptoms of cold or heat overexposure, or have been injured
on the job, will seek medical services. See also the Emergency Response (Section 6 of the HSP
for Petroleum Impacted Sites) for specific information regarding emergency services and logs,
reports, and record keeping; Section 2.1.5 of the HSP for Petroleum Impacted Sites, for
required report submittals. The map to the nearest medical facility is located in the front of
this document.

3.0 SITE CHARACTERIZATION AND HAZARD EVALUATION

The site characterization is provided below (Table 1) followed by a summary of physical and
operational safety hazards (Table 2), and chemical hazard information (Table 3).

TABLE 1
SITE CHARACTERIZATION

ANTICIPATED PHYSICAL STATE OF CONTAMINANT(S):

(x) Liquid ( ) Sludge ( ) Unknown
(x) Solid (contaminated soil) (x) Gas/ Vapors ( ) Other
Notes:

MATRIX:

(x) Surface soils (x) Surface water (x) Free product (possible)
(x) Soils at depth (x) Groundwater ( ) Other
Notes:

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
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AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com
TABLE 1 (Continued)
SITE CHARACTERIZATION

POTENTIAL HAZARDOUS PROPERTIES:

( ) Corrosive (x) Flammable/ Combustible ( ) Radioactive
( ) Toxic (x) Volatile ( ) Reactive
( ) Inert (x) Carcinogenic ( ) Unknown
( ) Asphyxiant (x) Compressed gas ( ) Other
Notes:

CONTAINER/ STORAGE SYSTEM INFORMATION:

( ) Tanks ( ) Landfills/Dumps ( ) Subsurface
( ) Drums ( ) Impoundments ( ) Uncontainerized
( ) Pipes ( ) Size/ capacity ( ) In-Service
( ) Quantity ( ) Surface (X) Other: Vacuum truck
Notes:

CONDITION OF CONTAINER/ STORAGE SYSTEM(S):

(X) Sound/ Undamaged ( ) Confirmed leaks
( ) Deteriorated/ Unsound ( ) N/A
( ) Unknown ( ) Suspected leaks
( ) Other
Notes:

ORIGIN OR INDUSTRIAL APPLICATION OF CHEMICALS OF CONCERN:

Industrial Process
( ) Manufacturing ( ) N/A
( ) Maintenance/ Repair ( ) Prev. Use
( ) Painting/ Coating ( ) Storage
(X) Power Generation ( ) Other
Notes:

Chemicals Used or Identified

( ) Acids ( ) Metals ( ) Phenols
( ) Caustics ( ) Pesticides ( ) Paints
( ) Halogen ( ) PCBs ( ) Solvents
(x) Other: petroleum fuel (diesel)
Notes:

Oils/Fuels

( ) Fuel Oil ( ) AVGAS ( ) Gasoline
( ) Waste Oil ( ) MOGAS (x) Diesel
( ) Hydraulic Oil ( ) Jet Fuel ( ) Other
Notes:

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 5

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

Sludges

( ) Metal sludges ( ) Oily sludges ( ) Septic sludges
( ) Other:
Notes:

Solids

( ) Asbestos ( ) Sandblast grit ( ) Landfill refuse
( ) Other:

Notes:

TABLE 2
SUMMARY OF PHYSICAL AND OPERATIONAL SAFETY HAZARDS
OPERATIONAL
SAFETY HAZARDS CONTROL OR PROTECTIVE MEASURES
Physical hazards
associated with drill rigs
and other heavy
equipment
See also Excavation, Trenching, Shoring SOP; Drilling Safety SOP, Equipment will be inspected
on a daily basis by the owner/operator, daily logs will be maintained. All discrepancies shall be
corrected prior to placing the equipment in service.

• Blades, buckets, and other heavy equipment will be kept fully lowered when not in use;
parking brakes must be engaged.
• Drill rods or core barrels shall not be left balancing, leaning, or other-wise unsecured on
the rig.
• Equipment parked on inclines shall have the wheels chocked or blocked and the parking
brake set.
• Equipment shall not be used on unstable or unsafe inclines.
Back injuries due to
improper lifting of
equipment
Workers will use proper lifting techniques, lifting with the legs and not the back. Loads >40 lbs.
require a second person or mechanical device.
Whenever possible, mechanical devices such as drum dollies, hand trucks and tool hoists (for
lifting augers) should be used to lift or move heavy loads.
Noise
Hearing protection shall be worn during operation of heavy equipment, pneumatic power tools,
steam cleaners and other equipment that potentially generates >85 dBA.
See also Hearing Conservation SOP, Vol. VI, Corp Health and Safety Manual.
Chemicals
A "toxic substance" is defined as any substance "which is listed in the latest printed edition of the
National Institute for Occupational Safety and Health Registry of Toxic Effects of Chemical
Substance" or has yielded positive evidence of acute or chronic health hazards in human, animal
or other biological testing." While this definition may seem unusually broad, the NIOSH Registry of
Toxic Effects of Chemical Substances alone lists over 85,000 toxic chemicals. This number does
not include substances for which no toxicity information exists (but which may have a
considerable toxic or hazardous potential).
General precautions:

• Know the composition of the materials you are using.
• Choose the safest materials possible.
• Use adequate ventilation.
• Protect yourself and the area against a potential fire.
• Have appropriate safety and personal protective equipment.
• Inspect all chemical containers before using them.
• Store and/or dispose of all unused chemicals immediately after use, in a proper
manner.

Inspect your own individual storage area regularly.
Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 6

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

TABLE 2 (Continued)
SUMMARY OF PHYSICAL AND OPERATIONAL SAFETY HAZARDS
Inclement weather
Work shutdown conditions:

• Poor visibility.
• Precipitation severe enough to impair safe movement or travel.
• Lightning in the immediate area.
• Steady winds >40 mph.
• Other conditions as determined by the SHSC, PM or HSM.
• Imminent threat of severe tropical storm or hurricane.

Complete an Incident Report (Appendix 3) within 24 hrs for all work shutdowns.
Domestic and Wild
Animals
Field employees are at risk from exposure to all types of animals, their waste products and their
carcasses. Rodents and other animals can harbor disease-causing agents very harmful to
humans. Care should be taken to avoid all wild animals and domestic animals that have the
potential to harm you. To avoid accident or injuries associated with rodents and other animals
observe the following guidelines:

• Be aware of your surroundings and note any wild or suspicious acting animals in your work area.
If necessary, seek safe shelter from these animals.
• Avoid reaching or stepping into or over hidden areas that may contain such animals.
• When working with soil, be aware of signs that indicate above or below ground animal nests and
take appropriate action to prevent contamination by dust or injury from bites.
• If an animal bite occurs, clean the wound with soap and water, and follow appropriate first aid
procedures. Immediately report the incident to your supervisor.
• Transport any bite victim to the hospital. (Have animal control safely capture the animal so it can
be tested for any known disease-causing agents.)
• If exposure to airborne particles and dust from a nest does occur, immediately report the
incident to your supervisor. (If possible, and without exposing yourself, mark the site without
disturbing it so trained personnel can collect samples to determine if any disease-causing
agents are present.)
• Avoid direct contact with bird, bat and other animal droppings. Areas where birds and bats roost
should be avoided or appropriate respiratory protection shall be used.
• Avoid direct contact with animal blood. Wear rubber gloves if contact with animal blood can not
be prevented. Dispose of rubber gloves properly. Wash hands thoroughly with an antibacterial
soap after disposal of rubber gloves and before eating, drinking or smoking.
Biological agents
• Workers will not be exposed to infectious agents or wastes with the current scope of work;
however, responders to first-aid incidents may contact bloodborne pathogens and will follow the
Bloodborne Pathogen Exposure Control Plan in this HSP.
• Workers shall be protected from hazards of irritant and toxic plants and be suitably instructed in
the first-aid treatment available.
• Personnel with known reactions to insect bites or stings should be identified during the "kickoff"
meeting so that the appropriate emergency treatment can be made available on-site. Locations
of any known bite or sting medication in the employee's possession will be identified daily.
• Workers should not attempt to capture any wild or semi-wild animals due to the possibility of a
bite or parasitic infection.
• Diminish exposure to dust when possible by wetting soil.

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
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AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com
TABLE 2 (Continued)
SUMMARY OF PHYSICAL AND OPERATIONAL SAFETY HAZARDS
Overhead Power/Utility
Lines
• Keep an eye out overhead at all times; take time to examine the hazard.
• Before operating equipment, make a safety plan that prevents contact.
• Take extra care and precautions.
• Check the height of you equipment or load.
• Plan your moves: are there power lines to pass under or avoid?
• Look out for uneven ground that may cause your vehicle to bounce.
• Think about wind and temperature - they may affect the power line's height.
• Never ride or climb on equipment or a load when near a power line.
• Work around power lines is to be done only during daylight hours.
• Don't ground your equipment around a power line.
• Do not allow equipment or objects to approach the overhead power line closer than the specified
safe limit of approach.
• If work is being carried out near the "safe limit of approach", use a trained signaler to act as an
observer to ensure that the required distance is maintained. (Communication by radio or air
horn.)
• Do not place materials under or adjacent to the overhead power line if it reduces the clearance
above ground required by O.H. & S. regulations. Contact the electrical utility for assistance to
determine the required clearance between the power line and the ground.
• Do not allow excavations to reduce the support required for power poles. Contact the electrical
utility to determine support required. Request line locators in case of grounding grids buried at
the base of power poles.
• Keep a safe working distance between your equipment and power lines
Housekeeping and
Sanitation
• Good housekeeping is important for maintaining a safe workplace.
• Each employee is responsible for maintaining a clean and sanitary
• All materials must be properly stored with stock being placed neatly in racks or bins wherever
possible.
• Clear all floors and walkways of tripping hazards on a regular basis.
• Place trash in proper receptacle.
• Do not throw it on the floor or ground.
Provide a waste receptacle that is in good condition and appropriate for the type of waste
material.
Entanglement in
rotating or moving
equipment
• Equipment shall not be operated without guards.
• Loose-fitting or dangling clothes, hair jewelry are prohibited.
• Stay clear of rotating augers and pinch points, such as cables and pulleys.
• Passage under, or stopping over, a moving stem or auger is prohibited.
• Drill crews are not allowed on the mast while the drill bit/auger is in operation or during transport.
• Long-handled shovels will be used to remove cuttings from the auger.
• Only the drill crew and the SHSC will be aware of the location and proper operation of the rig's
emergency shut-down equipment (kill-switches, etc.), and procedures.
Cold Stress
• See Cold Stress SOP, H-3.
• A worker should go immediately to a warm shelter if any of the following symptoms are spotted:
the onset of heavy shivering, frostnip, the feeling of excessive fatigue, drowsiness, and
irritability.
• If possible, a change of dry work clothing should be provided to prevent people from returning to
work with wet clothing.
• Alcohol should not be consumed while in the warmer environment.
• If possible, the most stressful tasks should be done during the warmer parts of the day. Double
shifts should be avoided. Rest periods should be extended to cope with increases in cold stress.
• A worker should weigh themselves at the beginning and end of the workday to check for weight
loss that might occur from progressive dehydration.

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 8

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

TABLE 2 (Continued)
SUMMARY OF PHYSICAL AND OPERATIONAL SAFETY HAZARDS
Heat Stress
• Provide shelter or shaded area for work tasks (as feasible) and break areas.
• Adjust work schedules by rotation of personnel or alternate job functions to minimize heat stress
or overexertion at one task.
• Work during cooler hours of the day (or night), as feasible.
• To maintain normal body fluid levels, drink 16 ounces (oz) (2 cups) of water before each shift
and about 8 oz (1 cup) every 15 to 20 minutes. Drink 2 gallons of water during an 8-hour period.
• Wear nonbinding cotton clothing (e.g., medical scrubs and cotton undergarments) under
personal protective equipment (PPE) to absorb moisture and to help prevent heat rash.
• Where feasible, set up field “showers” or hose-down areas to cool down body.
Slips, trips, and falls
• Clear work area of obstructions and debris prior to rig set-up.
• Level and stabilize the rig prior to raising the mast.
• Keep drill platforms, stairs, and immediate work areas clear; do not allow oil/grease and
excessive mud to accumulate in these areas.
• The discharge of drilling fluids and foam will be channeled away from the work area to prevent
ponding or slippery conditions.
• A safety harness and shock absorbing lifeline or adequate fall protection, shall be provided and
its use required for each employee working >6 ft. above the platform or main work deck.
• Open boreholes should be immediately backfilled, or be capped and flagged; open excavations
will be barricaded or be covered with steel traffic plates.
• Wherever possible, slip, trip and fall hazards will be eliminated or clearly identified with caution
tape, barricades, or equivalent means.
Field Emergency
Response
• Review Safe Operating Procedures for applicable equipment and perform pre-operational
checks.
• Make sure all emergency and warning lighting is working.
• Wear appropriate personal protection equipment consistent with the hazard.
• Protective clothing and other equipment may be required.
• Avoid working under suspended loads. Wear hard hats around backhoes, cranes and
excavators.
• Be alert for heat buildup, vapors, rumbling noises, leaks, dampness, unusual debris and
• Strange odors caused by airborne contaminants.
• Park in areas that: provide safe entrance and exit of work area; do not create potential conflicts
with other vehicles/equipment operating in the work area; and provide maximum protection for
workers entering and exiting the vehicle.
• Employees on foot must use caution to stay clear of operating equipment.
• Be aware of escape routes in case of emergencies. It is a good practice to work facing on-
coming traffic when on foot.
• Always establish eye contact with the operator before approaching equipment.
• Be aware of loose material, excavation drop-off, tripping hazards, uneven ground and other
obstructions.
• Take extra precautions to prevent heat and cold stress when working in extremely hot and cold
temperatures.
• Be aware of escape routes in case of emergency.
• All work should be performed in well ventilated areas.

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
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AMEC Environment & Infrastructure, Inc. Tel – [phone]
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TABLE 2 (Continued)
SUMMARY OF PHYSICAL AND OPERATIONAL SAFETY HAZARDS
OPERATIONAL
SAFETY HAZARDS CONTROL OR PROTECTIVE MEASURES
Poisonous Snakes,
Insects and Plants
Like most accidents and injuries, prevention is important in controlling hazards from poisonous
snakes, insects and plants. Therefore, each employee should review the work activities planned to
determine what exposures might exist. Efforts should then be made to minimize situations which
might result in a snakebite, insect sting or exposure to poisonous plants. Employees should also
avoid wearing bright clothes, perfumes, after-shaves, etc., to help minimize attraction of snakes or
insects.
Snakes
Employees should wear work boots, long pants and long sleeved shirts when going into hazardous
areas; make as much noise as possible when approaching a possible snake area to give the snake
time to leave; be equipped with a bush ax for clearing underbrush and for protection; avoid
reaching or stepping into hidden areas whenever possible.
If a snakebite should occur, the employee should:
a) Remain as calm as possible.
b) Move away from the snake.
c) Apply a constricting bandage (not tourniquet) between the wound and
heart. A finger should be able to pass under it. Apply ice to bite area, if available.
d) Allow a fellow worker to transport him/her to closest medical facility.
e) If possible, kill snake and carry to medical facility for identification.
Under no circumstances should incisions and suction be used to treat a snakebite unless:
a) The victim is over 1.5 hours from medical assistance, and
b) The person administering first aid has received advanced training in medical assistance such as
First Responder, EMT, etc.
Insect Stings
Employees should:
1. Wear appropriate clothing.
2. Avoid areas where insects might be whenever possible.
3. Schedule work in infested areas during the cool months.
4. Avoid high smelling after-shaves, colognes, etc., that may attract insects.
5. Use available insect repellents.
6. If a sting does occur, any stinger should be removed with a knife blade or fingernail. The area
should then be treated with Sting Kill Swabs and/or Hydrocortisone.
Ticks
Ticks are especially important because of the possibility of Rocky Mountain Spotted Fever or Lyme
Disease.
To minimize exposure, employees should follow these guidelines:
1. Wear appropriate clothing when working in wooded areas.
2. Check yourself at least twice a day, paying particular attention to the hair, neck and groin area.
3. Use the available Tick Repellent.
Poisonous Plants
The typical AEE employee has exposure to at least three types of poisonous plants: poison oak,
poison ivy and poison sumac. Reactions range from mild (very little or none) to severe (rash and
blisters).
To avoid problems with poisonous plants, employees should:
1. Avoid working in severely infested areas if at all possible. (Learn what the plants look like.)
2. Wear long sleeve shirts, long pants, and work gloves. If you are performing clearing activities
with either hand (e.g., bush axes, machetes, etc.) or powered tools use eye goggles/safety glasses
to prevent poisonous plants from entering your eyes.
3. Use silicone protective or other barrier creams where available.
4. Use TECNU Poison Ivy Wash on any place that may have been exposed. In some cases, even
24 hours after exposure may help.
5. Be sure that any clothes or shoes that may have been exposed receive a thorough washing.
Leftover oils on anything could cause a reaction even days later.
6. If a severe reaction develops, contact your medical provider for possible treatments.
7. Avoid rubbing your eyes if you have been in contact with poisonous plants.

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 10

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

Hazard Analysis of Site Work Tasks

TASK NAME: WELL INSTALLATION/DUAL PHASE EXTRACTION
Potential Hazards: (Check all that apply to either existing conditions or that result from site operations)
(x) Rotating Machinery ( ) Projectiles ( ) Confined Space
(x) Heat Stress (x) Physical Exertion (x) Biological (plants, rodent virus,
( ) Cold Stress (x) Noise (>85 dBA) marine species, soilborne or
(x) Heavy Equipment (x) Vehicle Traffic waterborne fungi/bacteria, insects,
(x) Intrusive Activ's (underline) (x) Fire/ Explosion (underline) arachnids, snakes, wild
• Trenching • Flam. Materials animals) †
• Drilling • Low-lying Areas (x) Electrical (utilities)
• Soil Vapor Surv. • Fuel lines (x) Chemical Exposure
• Sampling ( ) Other (List)
(x) Uneven terrain, slips, trips, falls ( ) Work near water (lagoons,
( ) Trench/excavation collapse streambeds, ravines, bay ocean)
†Insects such as bees and wasps. Arachnids such as ticks, scorpions, and spiders. Consult with the Corporate HSE Director or
regional HSE Manager for protective measures against viruses or fungi.

Control or Protective Measures: (see also Table 2)
(x) Tailgate Meetings (x) PPE ( ) Air Monitoring
(x) Operator Training (x) Site Control (x) Decontamination
(x) Engineering Controls: Work Zones
(x) SOPs: See Table 2
( ) Other:

PERSONAL PROTECTIVE EQUIPMENT
Initial levels of protection have been assigned for this work task based on the potential risk of exposure. Levels may
be upgraded or downgraded depending on site conditions, as determined by the SHSC. Any modification to the levels
of PPE below must be noted here and documented with a completed ROC form (see Appendix 2 for blank forms).
Level Of Protection: ( ) A ( ) B ( ) C ( ) D (x) Modified D
Respirator: (Level C and above)
( ) SCBA, Airline ( ) Purif. Resp. ( ) Escape Mask
( ) OV/AG Cart. ( ) Other
Protective Clothing: ( ) Encap. Suit ( ) Tyvek® ( ) PE Tyvek®
( ) Saranex ( ) Splash Suit (x*) Safety Vest
(x) Other Field clothing to protect from cold/sun/heat exposure- long pants,
shirts (cotton) with sleeves. Rain gear should be available when conditions
warrant.
Head/Eye/Ear: (x**) Hard Hat (x) Safety Glasses ( ) Goggles
( ) Splash Shield (x) Ear Plugs/ Muffs
( ) Other
Gloves: (outer) (x) Nitrile (4 gauge or >) ( ) Neoprene ( ) PVC
(inner) ( ) N-dex Nitrile ( ) Vinyl ( ) Other
Footwear: (x) Safety-toe (steel toed) ( ) Overboots
( ) Safety-toe Rubber ( ) Other

Modifications Permitted: As determined by the SHSC. * Safety vests are required in areas where
vehicles are operated, parked, and around roadways for visibility. **Hard hats will be worn when around
heavy equipment operation.
X = required PPE; * = modifications permitted; † =in case of upgrade.

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 11

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

TABLE 3
CHEMICAL HAZARD INFORMATION
Chemical
Name
Route of
Exposure Potential Concerns Control Measures
Petroleum Related COCs
Benzene
Ingestion; Skin
Absorption; Skin
and/or Eye Contact;
Inhalation
*Confirmed human
carcinogen (causes
cancer)
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
Toluene
Ingestion; Skin
Absorption; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
Ethylbenzene
Ingestion; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
Xylenes
Ingestion; Skin
Absorption; Skin
and/or Eye Contact;
Inhalation

Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed in
the work area.
Sec-Butylbenzene
Ingestion; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
Methyl Tert butyl
Ether
Ingestion; Skin
Absorption; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
Isopropyl ether
Ingestion; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
Isopropylbenzene
Ingestion; Skin
Absorption; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
N-propylbenzene
Ingestion; Skin
Absorption; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 12

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com
Chemical
Name
Route of
Exposure Potential Concerns Control Measures
1,3,5-
Trimethylbenzene
Ingestion; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
1,2,4–
Trimethylbenzene
Ingestion; Skin
and/or Eye Contact;
Inhalation

Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
n-butylbenzene
Ingestion; Skin
Absorption; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
Naphthalene
Ingestion; Skin
Absorption; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed
in the work area.
Lead
Ingestion; Skin
and/or Eye Contact;
Inhalation
Personnel may come into
brief contact when
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses/ goggles when
handling soil and groundwater. Personnel should wash
hands and face as soon as possible after work cessation
and/or before eating, drinking, using the restroom, or
smoking. No eating, drinking or smoking will be allowed in
the work area.
Fuels
TPH fuels as
Gasoline
Ingestion; Dermal;
Inhalation
*Possible human
carcinogen (causes
cancer)
Personnel may come into
brief contact when
groundwater/ soil
sampling, handling waste,
and preparing samples for
shipment.
Wear protective gloves and safety glasses when handling
soil. Personnel should wash hands and face as soon as
possible after work cessation and/or before eating,
drinking, using the restroom, or smoking. No eating,
drinking or smoking will be allowed in the work area. TPH fuels as
Diesel
Ingestion; Dermal;
Inhalation

4.0 EMERGENCY REFERENCE LIST

Responding Emergency Agencies

SERVICE NAME CONTACT NUMBER
Ambulance Local EMS 911
Fire Department Local Fire 911
Police Department Local Police 911
National Response Center N/A 800-424-8802
Poison Control Center N/A 800-222-1222
OSHA N/A 800-321-OSHA (6742)

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 13

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

AMEC Call List:

TITLE NAME CONTACT NUMBER
WorkCare 24/7 Hotline (Must Call Within 1 Hour) [phone]
Department Manager Susan Johnson [phone]
Project Manager Harold Thurston [phone] (office)
[phone] (cell)
Field Team Member/ SHSC Anthony Kellogg [phone] (cell)
CHSD Vlad Ivensky [phone]
HSE Coordinator Michael McKenna [phone]
Client Contact Mark Davis [phone]
NC One Call N/A [phone]
*In the event of an occupational accident or incident, please indicate to the medical facility that this is
a Workers' Compensation case.

EMERGENCY FIRST AID PROCEDURES
To Stop Bleeding CPR

1. Give medical statement.
2. Assure airway, breathing, and circulation.
3. Use DIRECT PRESSURE over the wound with
clean dressing or your hand (use non-
permeable gloves). Direct pressure will control
most bleeding.
4. Bleeding from an artery or severe injury may
require DIRECT PRESSURE on a PRESSURE
POINT. Use pressure points for 30 – 60
seconds to help control severe bleeding.
5. Continue primary care and seek medical aid as
needed.

1. CHECK the scene and ill/ injured person.
2. CALL 911.
3. CHECK for breathing, if not, give 2
rescue breaths.
4. If no sign of life or movement, give CARE
by starting CPR.
5. Chin lift and give 2 rescue breaths
followed by 30 chest compressions until
a more qualified person arrives, there are
no signs of life, or you are too tired to
continue.

Health & Safety Plan
Food Lion Distribution Center #4
Dunn, North Carolina
Page 14

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

5.0 HEALTH AND SAFETY PLAN ACCEPTANCE

I have had the opportunity to read and ask questions about both this Site-Specific HSP and the
HSP for Petroleum Impacted Sites. My signature certifies that I understand the
procedures, equipment, and restrictions of this plan and agree to abide by them.

PRINTED NAME SIGNATURE* COMPANY DATE

* This acceptance form is required for all routine site staff and subcontracting personnel.

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com
APPENDIX 1

SITE LOCATION MAP

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com
HOSPITAL ROUTE MAP

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, NC 27703 www.amec.com

APPENDIX 2

SITE FORMS

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Check one
Initial Report: Update:
Final Report:

INCIDENT ANALYSIS REPORT
AMEC Environment & Infrastructure
Confidential - Privileged

Incident Potential
Letter: Select One Number: Select One Investigation Level: Select One

Group: Select One Group HSE Manager: Incident Review Panel Team (if applicable):
Incident Date: Report Date:
Section 1 – General Information
Employee Name: Sex: M F Date of Birth: Age Range: Select One
Job Position: Select One Hire Date: Time employee began work: Time of incident: am | pm
Business Line: Select One Department Number: Project Manager:
Project Name: Project Number: Client:
Office where employee works from: Immediate Supervisor: Hours employee worked during last 7 days: hrs
Location: Select One Is this a Company controlled work site: Yes No Incident Assigned to: Select One
Location description:

Section 2 – Incident Type - Process (mark at least ONE BOLD TYPE and all that apply)
Fatality Environmental Injury/Illness Incident If Injury/illness: Select One
Security Near Miss / Hazard ID Property Damage If Damage: Select One 3rd Party?
Hospitalization Regulatory Inspection Notice of Violation or Citation Agency Reportable?
Motor Vehicle Incident Involving Injury Other (describe):
Outcome/Result: Select One Source of Hazard: Select One If “other”, specify: Immediate Cause: Select One
A. If injury/illness: Indicate the part of the body: Select One If “other”, specify:
Indicate body part location: Select One If “other”, specify:
Injury Type: Select One If “other”, specify: Illness Type: Select One If “other”, specify:
B. If property damage: describe what happened and estimate ($) of damage to all objects involved?
C. If environmental: Type of Environmental incident?: Select One Name, CAS#, physical state and quantity?
Receiving Environment?: Select One Mechanism of Incident?: Select One If “other”, specify:
Nature of Breach?: Select One Duration of Breach?: Select One
D. If security: Security Incident Type: Select One If Physical: Select One If Criminal: Select One If Intellectual: Select One
E. If an inspection by a regulatory agency, what agency, who were the inspectors, inspector contact information?
Section 3 – Incident Description
Attach and number additional pages, as needed, to ensure all details related to the incident are captured.
A. List the names of all persons involved in the incident, and employer information:
B. List the names of any witnesses, their employer, and a local/company telephone number or address:
C. Name of Employee’s supervisor: Contact phone number for supervisor:
D. What specific job/task or action was the employee(s) doing just prior to the incident:
E. Was a tool or equipment involved? Yes No What was it: Last Inspection Date: Defects:
F. Explain in detail what happened:

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G. Explain in detail what object or substance directly harmed the employee:
H. What were the weather conditions at time of incident?:
I. What was the lighting like at time of incident? Bright Shadows Dark Other:
J. List any damaged equipment or property (other than motor vehicles). Provide model and serial number and estimated costs to repair/replace damaged equipment or property, if applicable:

Section 4 - Incident Analysis

A. Was a Health and Safety Plan (HASP) or Activity Hazard Analysis (AHA) completed for the work being performed? Yes No
If “yes”, Who prepared the document?:
B. Who and when was the last manager (Project, Unit, etc.) at the site of the incident?:
C. When and what safety training directly related to the incident has the person(s) involved had?:
D. List attached documentation (HASP acknowledgement forms, kickoff/daily/weekly meetings, inspections, photographs):

Section 5 - Incident Investigation Results and Corrective Actions
This section to be completed by the Group HSE Manager/IRP with support from location where incident occurred, in accordance with AMEC A-Z List of Accident Causes.
Causal Factors (Acts or Omissions / Conditions)
(Attach and number any additional pages as needed to completely address this section)
IMMEDIATE CAUSE IMMEDIATE CAUSE SUB-TYPE DESCRIPTION
1 Select One
2 Select One
3 Select One
4 Select One
Root Cause(s) Analysis - The below items represents major root cause categories which have been determined to be Less Than Adequate (LTA). A more detailed
determination of the root cause will be facilitated, if needed, by the applicable Group HSE Manager / IRP.
ROOT CAUSE TYPE ROOT CAUSE SUB-TYPE DESCRIPTION
1 Select One
2 Select One
3 Select One

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4 Select One
Corrective Actions
Root Cause #
Corrective Actions Taken (Attach additional pages as needed to completely address this section) Responsible Person
Proposed
Completion
Date
Closed on
Date
Verified by and
Date Verified

Section 6 - Notifications, Certification & Approvals
Check the appropriate boxes indicating the applicable reports have been made to the following applicable organizations:
Auto Insurance Carrier was called Group HSE Manager Notified
WorkCare was called Post-incident Drug/Alcohol Testing Performed

Incident Report prepared by:
Employee (s):
Date: Employee’s Supervisor:
Date:

HSE Coordinator/Project/Unit Manager:
Date:
Group HSE Manager:
Date:

© AMEC 2012 1

ATTACHMENT 2
VEHICLE INCIDENT REPORT
Confidential - Privileged
Section 1 - General Information Date of Incident:
Time incident occurred: am | pm | Illumination: Dark Dusk Light | Road Condition: Dry Wet Icy/snow Were police summoned to scene? Yes No Police Department and Location:
Report #; Officer’s Name: Officer’s Badge Number:
Section 2 - Company Driver and Vehicle
Driver's name: D/L #: State:
Driver's home office address: Driver’s Phone #:
Company Vehicle #: Year: Model: License #: State:
Company car?: Yes No Personal Vehicle?: Yes No Rental Vehicle?: Yes No
If rental, rented from:
Passenger/Witness Name(s): Address: Telephone:
Passenger/Witness Name(s): Address: Telephone:
Damage to vehicle:
Was an employee injured?: Yes No If yes, please describe:
Injuries to others?: Yes No If yes, please describe:
Vehicle was being used for: Company business Yes No Personal business Yes No
Towed?: Yes No If yes, by whom?: To Where?:
Section 3 - Other Driver and Vehicle Information
Driver's Name: D/L # : State:
Current address: City: State:
Telephone: Work: Cell:
Registered Owner's Name: Address: City: State:
(verify registration document)
The Other Vehicle: Make: Model: Year: License #: State:
Insurance company name: Address: Phone #:
Policy No.: Contact Person: Phone #:
Passenger/Witness Name(s): Address: Telephone:
Passenger/Witness Name(s): Address: Telephone:
Damage: (Make note of pre-existing damage and take pictures if possible – you may attach additional pages if necessary):
Injuries to other driver/passengers:
Section 4 – Approvals (signatures required)
Form completed by (please print): Date: Office/Project Manager (please print): Date:
Signature: __________________________________________ Signature: __________________________________________

© AMEC 2012 2
Things to Do First In The Event Of a Motor Vehicle Incident

GENERAL INFORMATION 1. Do not decide on your own whether a particular incident is “covered” by insurance. Should there be any doubt, it is always preferable to report an occurrence, as this allows underwriters, the Risk Management Department and insurance
adjusters to determine if a covered loss has taken place.
2. Policy Conditions do require that all losses and occurrences, which may result in a claim be promptly reported.

3. Do not admit liability or offer your opinion of liability to anyone.

4. Complete this IAR/VIR form promptly and forward with all applicable supporting documentation. It is essential both
division and location information be provided.
5. For automobile collisions within the United States, please indicate on the IAR form that you have contacted Zurich at: Zurich Insurance Company 1-800-987-3373 or 1-877-928-4531 24 hours a day, 7 days a week 6. For automobile collisions within Canada, please indicate on the IAR form that you have contacted Zurich at: Crawford Adjusters Canada Claims Alert 1-888-218-2346
24 hours a day, 7 days a week The more details you have the better but, don’t delay reporting if you don’t have all of the information - that may be obtained later. A Zurich trained operator will answer your call and ask for all relevant information regarding the incident.
The initial information required includes:
 Your division,
 Office location and division contact name – advise that you are an AMEC Company
 Name, drivers license and phone number of the driver involved in the loss
 Description of the vehicle which he/she was driving (i.e., year, make, model, license plate number, serial number)
 Date, time and location of incident
 Passenger information (if applicable)
 Third party information (i.e., name, phone number, address, vehicle information, insurance information)
 If any injuries occurred (if applicable)
 Police information
 Witness information (if applicable) Call 911 if there are serious injuries!
If you are injured or think you were injured, contact your supervisor and call WorkCare at 888-449-7787. Your supervisor will notify your HSE Coordinator and your Group HSE Manager. For additional instructions on what to do, go to AMEC’s HSE website at: http://ee.amecnet.com/she/sheweb/incident_reporting.htm 1. Call for an officer if the incident occurred on public property (streets, highways or roads). Disputes often arise between the parties involved as to who was at fault; therefore, a police report is important. If an officer is unable to attend the scene of the collision, a counter police report may be filed at most stations. Insurance companies rely on police reports to determine liability. 2. Complete the Incident Investigation Report and the Vehicle Incident Report forms. It is important that both these forms are completed in detail. Include a diagram of the incident on the provided sheet. Incomplete information may lead to delays in processing associated claims and in helping to prevent this type of incident from occurring again. 3. Give only information that is required by the authorities or as directed by AMEC contractual requirements. 4. Sign only those statements required by the authorities or as directed by AMEC contractual requirements. Do not sign away your or the company's rights.
© AMEC 2012 3
Vehicle Incident Diagram
This or a similar diagram must be completed with all VIRs

ATTACHMENT 3

1. Number each vehicle and show directions
2. Use a solid line to show path before incident and use a dotted line to show path after incient
3. Show pedestrian/non-motorist by:
5. Indicate north by arrow as:
6. Show street or highway names or numbers
7. Show signs, signals, warning and traffic controls.
Prepared by:Date:
4. Show railroad by:
Indicate Northby Arrow
(after)(before)
Instructions:
1 2
1 1

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GROUND DISTURBANCE INCIDENT REPORT
AMEC Environment & Infrastructure

Section 1 – General Information

Employee Name: Time of incident: am | pm Time Reported: am | pm Report Date:
Project Name: Project Number: Client:
List of All Parties Present
Name Company Telephone No. Role

Describe the chronological description of Incident and response:

Section 2 – Date and Location of Event

A. *Date of Event: (MM/DD/YYYY)
B. *Country *State *County City

C. Street address Nearest Intersection

D. *Right of Way where event occurred E. Public: City Street State Highway County Road Interstate Highway Public-Other
F. Private: Private Business Private Land Owner Private Easement G. Pipeline Power /Transmission Line Dedicated Public Utility Easement
Federal Land Railroad Data not collected Unknown/Other
List attached documentation (Public Utility Locates, Private Utility Locates, Copy of notifications submitted to Owner or other utility Owners, photographs):

Section 3 – Affected Facility Information
*What type of facility operation was affected?
Cable Television Electric Natural Gas Liquid Pipeline Sewer (Sanitary Sewer) Steam Telecommunications Water Unknown/Other
*What type of facility was affected?
Distribution Gathering Service/Drop Transmission Unknown/Other Was the facility part of a joint trench?
Unknown Yes No Was the facility owner a member of One-Call Center?
Unknown Yes No

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Section 4 – Excavation Information
*Type of Excavator
Contractor County Developer Farmer Municipality Occupant Railroad State Utility Data not collected Unknown/Other *Type of Excavation Equipment Auger Backhoe/Trackhoe Boring Drilling Directional Drilling
Explosives Farm Equipment Grader/Scraper Hand Tools Milling Equipment Probing Device Trencher Vacuum Equipment Data Not Collected Unknown/Other
*Type of Work Performed
Agriculture Cable Television Curb/Sidewalk Bldg. Construction Bldg. Demolition Drainage Driveway Electric Engineering/Survey Fencing
Grading Irrigation Landscaping Liquid Pipeline Milling Natural Gas Pole Public Transit Auth. Railroad Maint. Road Work
Sewer (San/Storm) Site Development Steam Storm Drain/Culvert Street Light Telecommunication Traffic Signal Traffic Sign Water Waterway Improvement
Data Not Collected Unknown/Other

Section 5 – Pre-Excavation Notification
*Was the One-Call Center notified?
Yes No If Yes, which One-Call Center? Ticket number: Was Private Contract Locator used?
Yes No

Section 6 – Locating and Marking
*Type of Locator Utility Owner Contract Locator Data Not Collected *Were facility marks visible in the area of excavation?
Yes No Data Not Collected *Were facilities marked correctly? Yes No Data Not Collected What technology was used to locate utilities? Maps Active(transmitter+receiver) Passive (receiver only) GPR
Acoustic Magnetic Infrared Unknown/Other What Factors affected the ability to locate services?
Soil Type:__________ Non-Grounded Common Bonded Depth Electromagnetic interference Parallel facilities Congested facilities Unknown/Other

Section 7 – Excavator Downtime
Did Excavator incur down time?
Yes No If yes, how much time?
Unknown Less than 1 hour 1 hour 2 hours 3 or more hours Exact Value ______If Estimated cost of down time?
Unknown $0 $1 to 500 $501 to 1,000 $1,001 to 2,500 $2,501 to 5,000 $5,001 to 25,000 $25,001 to 50,000 $50,001 and over Exact Value ______

Paper copies are uncontrolled. This copy was valid at the time it was printed. For an up-to-date copy, please visit AMECnet. 3

Section 8 – Description of Damage

*Was there damage to a facility? Yes No (i.e. near miss) *Did the damage cause an interruption in service? Yes No Data Not Collected Unknown/Other If yes, duration of interruption
Unknown Less than 1 hour 1 to 2 hrs 2 to 4 hrs 4 to 8 hrs 8 to 12 hrs 12 to 24
hrs 1 to 2 days 2 to 3 days 3 or more days Data Not Collected Exact Value _______ Approximately how many customers were affected? Unknown 0 1 2 to 10 11 to 50 51 or more Exact Value _______ Estimated cost of damage / repair/restoration
Unknown $0 $1 to 500 $501 to 1,000 $1,001 to 2,500 $2,501 to 5,000
$5,001 to 25,000 $25,001 to 50,000 $50,001 and over Exact Value ______ Number of people injured
Unknown 0 1 2 to 9 10 to 19 20 to 49 50 to 99 100 or more Exact Value _______ Number of fatalities
Unknown 0 1 2 to 9 10 to 19 20 to 49 50 to 99
100 or more Exact Value _______
Was there a Product Release?
Product Release: No Yes N/A Type: If Yes, Incident Type is Environmental Report.
Volume: Spill Controls: Repair Process:

Section 9 – Description of the Root Cause
Please choose one One-Call Notification Practices Not Sufficient Locating Practices Not Sufficient
No notification made to the One-Call Center │ Facility could not be found or located Notification to one-call center made, but not sufficient │ Facility marking or location not sufficient
Wrong information provided to One Call Center │ Facility was not located or marked │ │ Incorrect facility records/maps
Excavation Practices Not Sufficient │ Miscellaneous Root Causes
Failure to maintain marks │ One-Call Center error Failure to support exposed facilities │ Abandoned facility
Failure to use hand tools where required │ Deteriorated facility Failure to test-hole (pot-hole) │ Previous damage
Improper backfilling practices │ Data Not Collected Failure to maintain clearance │ Other
Other insufficient excavation practices │

Paper copies are uncontrolled. This copy was valid at the time it was printed. For an up-to-date copy, please visit AMECnet. 4

Section 10 - Notifications, Certification & Approvals
Check the appropriate boxes indicating the applicable reports have been made to the following applicable organizations:
One Call was called Spills Reporting Agency Notified
Emergency Responders (Fire) was called Post-incident Drug/Alcohol Testing Performed

List of All Agencies Contacted
Name/Agency Phone # Date Time

Incident Report prepared by:
Employee (s): Date: Employee’s Supervisor: Date:
HSE Coordinator/Project/Unit Manager: Date: Group HSE Manager: Date:

JHA No.: JHA - RALE - ??? Rev 00
Job Hazard Analysis

Job/JHA Title: Vehicle Travel (via car or truck) Date of Analysis:
Job Location: N/A Team Leader: N/A

Work Activity Description (begin on next line)
Travel (via car or truck) while on Company business
Instructions: The Team Leader will gather the appropriate team, including subject matter experts,
operators, and support personnel, to analyze the job for hazards. Using the table below or similar format, address the four phases of this process:

• Identify Key Job Steps: Break the job down into individual key steps where work activities are presented in sequential order.

• Identify Job Hazards: Create a list of known or potential hazards within each step of the job.
Consider hazards associated with the various tools, equipment or other hardware involved in the job. Consider environmental hazards such as thermal stress, biohazards, etc.
• Identify Safe Practices and Equipment: List one or more prevention or control measures to address each hazard identified, emphasizing engineering and administrative controls over PPE. Once
this has been completed, the JHA Team will determine whether the job can be performed in a manner
that eliminates the identified hazards.
• Identify Hazards and PPE: Complete the checklists for hazard identification and PPE requirements. Information from the RA and applicable permits are included in this section.

Assess Work Activity
Key Work Steps Hazards/Potential Hazards Safe Practices
Prepare for travel Distractions - loss of focus  Ensure you have all materials with you necessary to conduct work effort.
 Determine training and medical monitoring needs
and ensure all required Health and Safety training and medical monitoring has been received and is current.
 Ensure all workers are fit for duty (alert, well rested, and mentally and physically fit to perform
work assignment).
 Familiarize yourself with route to destination.
 Ensure that a copy of the current insurance
certificates and incident reporting procedures/forms are available during travel.

JHA No.: JHA - RALE - ??? Rev 00
Job Hazard Analysis

Prepare for travel (concluded) Vehicle defects Inspect vehicle for defects such as:
 Inadequate fluids (e.g., fuel, antifreeze, oil, windshield washer)
 Worn/flat tires
 Windshield wipers loose, worn, or torn
 Oil puddles under vehicle
 Headlights, brake lights, turn signals not working
 Exterior or interior damage (e.g., scratches, dents)
Insufficient emergency equipment, unsecured loads

 Ensure vehicle has first aid kit and that all medications are current (if first aid kits are not provided at the site).
 Ensure vehicle is equipped with warning flashers and/or flares and that the warning flashers work.
 Cell phones are recommended to call for help in the event of an emergency.
 Vehicles carrying tools must have a safety cage in
place; all tools must be properly secured.
 Ensure parking cones are present, if applicable.
Operating vehicles

Collisions, unsafe driving conditions  Drive defensively!
 Do not use cruise control during inclement
weather.
 Do not drive more than 500 miles per day or for extended distances from 11:00pm to 5:00 am.
 Do not eat or use tobacco products in the vehicle.
 No unrestrained pets or nonwork riders (e.g., hitch hikers, girl friend, mother-in-law) allowed in
vehicles.
 Seat belts must be used at all times when operating any vehicle on company business.
 Drive at safe speed for road conditions.
 Maintain adequate following distance.
 Pull over and stop if you have to look at a map or
use a cell phone.
 Try to park so that you don’t have to back up to leave.
 If backing is required, walk around vehicle to identify any hazards (especially low level hazards that may be difficult to see when in the vehicle) that might be present. Use a spotter if necessary.
Dusty, winding, narrow roads  Go slow around corners, occasionally clearing the windshield.
Rocky or one-lane roads  Stay clear of gullies and trenches, drive slowly over rocks.
 Yield right-of-way to oncoming vehicles---find a safe place to pull over.

JHA No.: JHA - RALE - ??? Rev 00
Job Hazard Analysis

Operating vehicles (concluded) Stormy weather  Inquire about conditions before leaving the office.
 Be aware of oncoming storms.
When angry or irritated  Attitude adjustment; change the subject or work out the problem before driving the vehicle. Let someone else drive.
Turning around on narrow
roads
 Safely turn out with as much room as possible.
 Know what is ahead and behind the vehicle.
 Use a spotter if available.
Sick or medicated  Let others on the crew know you do not feel well.
 Let someone else drive.
On wet or slick roads  Drive slow and safe.
Animals on road  Drive slowly, watch for other animals nearby.
 Be alert for animals darting out of wooded areas
Vehicle accident  Employees should follow MACTEC vehicle operation policy and be aware of all stationary and
mobile vehicles.
Parking at job site Striking other vehicles, objects  Choose parking spot that is away from other
vehicles, if possible.
 Choose a spot that will allow the driver to drive forward when leaving the site.
 Back into parking spots, or pull through when parking in perpendicular parking spaces (drive
forward into angle/herring bone type parking spots).
 Place cones in front of and behind company-owned vehicles as applicable.
Leaving parking spaces  Walk around the vehicle before leaving and
identify hazards (low lying objects, location of other vehicles or pedestrians, other vehicles with drivers that may be leaving at the same time, etc.
 Collect cones (Company vehicles only) and secure them into their holder.
 If backing is unavoidable, use a spotter if a second
person is available; if no spotter available, back slowly, checking for other vehicles, pedestrians,
etc.
 Keep alert!
Driving back from the job site See hazards listed for “Operating vehicles” Key Work Step
See safe work practices for “Operating vehicles” Key Work Step
Parking at office Striking other vehicles, objects See safe work practices for “Striking other vehicles, objects” Hazard/Potential Hazard for “Parking at job site” Key Work Step
End travel Vehicle defects  Inspect vehicle.
 Repair or initiate repair of all vehicle deficiencies
that occurred due to the trip.

JHA No.: JHA - RALE - ??? Rev 00
Job Hazard Analysis
Complete the following checklists for hazard identification and PPE requirements. Information from the
RA and applicable permits are included in this section. Hazard Identification

Standard Hazards
Falling Objects Slips and Trips Pinch Points Rotating Equipment
Falls Power Equipment / Tools Elevated Work Surfaces
Eye Hazards
Particulates Liquid Splashes Welding Arc
Hearing Hazards
None Impact Noise High Frequency Noise High Ambient Noise
Respiratory Hazards
None Dust / Particulates Organic Vapors Acid Gases
Oxygen Deficient Welding Fumes Aerosols / Particulates Be, Hg, Cr, Pb
Radon Asbestos
Chemical Hazards
None Organic Solvents Reactive Metals PCBs
Acids / Bases Oxidizers Volatiles / Semi-volatiles
Environmental Hazards
None Temperature Extremes Wet Location Bio Hazards (snakes,
insects, spiders, bird / mouse droppings, fungus, etc.)
Explosive Vapors Confined Space Engulfment Hazard
Electrical Hazards
None Energized Equipment or Circuits
Overhead Utilities Underground Utilities Hidden Utilities
Wet Location
Fire Hazards
None Cutting, Welding, or Grinding Generated
Sparks or Heat Sources
Flammable Materials Present Oxygen Enriched Location

JHA No.: JHA - RALE - ??? Rev 00
Job Hazard Analysis
Hazard Identification (concluded)

Ergonomic Hazards
Lifting Bending Twisting Pulling / Tugging
Computer Use in the:
Office Field Repetitive Motion
Radiological Hazards
None Loose Contamination Fixed Contamination Radiation
Airborne Contamination Radon EMF Criticality
Alpha Beta Gamma / X-rays Neutron
Tritium TRU Depleted Uranium Enriched Uranium
Other Hazards

Hazard identification completed by: Date:

JHA No.: JHA - RALE - ??? Rev 00
Job Hazard Analysis
PPE and Monitoring Requirements
Standard PPE
Hard Hat Safety Shoes Safety Glasses Boot Covers
Aprons Rubber Boots
Eye Protection
Welding Glasses Welding Helmet Face Shield Chemical Goggles Welding Screens
Hearing Protection
Ear Plugs Ear Muffs Ear Plugs and Muffs
Respiratory Protection
None Dust Mask Full Face APR Half Face APR
Cart. Type
PAPR
Cart. Type
SCBA Airline Respirator
Protective Clothing
Tyvek® Coveralls Poly-coated Tyvek® Coveralls Saranex® Coveralls Fully Encapsulating Suit
Cotton Coveralls Modesty Clothing Fire Resistant Clothing
Hand Protection
None Cotton Gloves Leather Gloves Glove Liners
Nitrile Gloves Viton® Gloves
Butyl Gloves
Neoprene Gloves
Surgical Gloves Latex
Non-Latex
Cut-resistant Gloves
Monitoring Requirements
Oxygen Flammable Gases/Vapors Toxic Gas/Vapors H2S/CO
Asbestos Full-time IH Coverage Part-time IH coverage Be, Hg, Cr, Pb
Metals (specify):
Organic Vapors (specify):
Radioactive Air Particles TLD Required CAM Radon
Full time RCT Coverage Part-time RCT Coverage Radioactive Air Particles

PPE and monitoring requirements completed by: Date:

JHA No.: JHA - RALE - ??? Rev 00
Job Hazard Analysis

JHA Preparation Team

Effective Date: from continuous through continuous
(Periodic review required)

Approvals
(Signatures)

Job Supervisor/Team Lead Date Group HSE Coordinator Date

Project Manager Date Raleigh HSE Manager Date

RSO Date Office Manager Date

Regional HSE Manager Date Other - Group Expert Date

Other - Date Other - Date

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180
APPENDIX B

AGGRESSIVE FREE VAPOR RECOVERY (AFVR)
VACUUM LOGS

AMEC: Food Lion Dunn, NCAFVR Event #4--July 2014Truck Vacuum was 24" all other readings are at well headRW-7RW-8RW-9RW-3RW-2RW-4RW-1RW-5RW-68:002423247:302022247:002430309:002423258:302024248:0022283010:002423249:302024259:0022283011:0023232410:3020252510:0022262812:0023222511:3020252511:002226281:0024232412:3022252412:002226282:002423241:302024241:002226283:002322242:302024242:002226284:002323243:302024253:002226287/28/2014 7/29/2014 7/30/2014

AMEC Environment & Infrastructure, Inc. Tel – [phone]
4021 Stirrup Creek Drive, Suite 100 Fax – [phone]
Durham, North Carolina 27703 www.amec.com
Licensure: NC Engineering F-1253; NC Geology C-180
APPENDIX C

INVESTIGATION-DERIVED WASTE (IDW)
DISPOSAL DOCUMENTATION