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U-Haul <br /> Facility Number 709-83,450 North Cherokee Lane <br /> Lodi, California <br /> WPI Project#96237 <br /> HEALTH AND SAFETY PLAN <br /> Page 21 <br /> SECTION 8.0 <br /> WAYNE PERRY,INC. <br /> HEALTH AND SAFETY PLAN <br /> FIELD PERSONNEL RELEASE FORM <br /> 1, , do hereby confirm that I <br /> have read and understand the Health and Safety Plan for Project No. 96.237, U-Haul Facility <br /> Number 709-83,450 North Cherokee,Lodi, California. <br /> I do agree to follow this plan, and to make every effort to make the workplace safe. I will <br /> report any health or safety hazard that I observe to the Senior Safety Officer, Site Safety Officer, <br /> or Project Supervisor. <br /> I do agree to defend, indemnify, and hold harmless Wayne Perry, Inc., its owners, <br /> employees, representatives, clients, and the property owner for any accidents, sickness, or <br /> injuries resulting from the violation, alleged violation, or non-compliance of this Health and <br /> Safety Plan. <br /> Name: Title <br /> Signature: Date: <br /> Name: Title <br /> Signature: Date: <br /> Name: Title <br /> Signature: Date: <br /> Name: Title <br /> Signature: Date: <br />