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RECEIVED <br /> MAY 0 6 2015 <br /> TAIT ENVIRONMENTAL SYSTEMS <br /> ENVIRONMENTALHEALTI--1 SAFETY COMPLIANCE AGREEMENT <br /> PERMIT/SERVICES <br /> Project Number: <br /> Project Title: <br /> I, (print name), have reviewed the copy of the entire Health and Safety <br /> Plan for the above referenced project. Visitors will also be required to review it. I have read <br /> the plan, understand it, and agree to comply with all of the Health and Safety Requirements. I <br /> understand that I may be prohibited from working on the project for violating any of the <br /> requirements. Visitors will be required to be escorted in the restricted access zone. Visitors <br /> must comply with Tait Environmental Systems escort directions while on-site at all times. <br /> Non-compliance with escort directions will not be tolerated, and violators will be requested to <br /> leave the site immediately. <br /> A physician based on medical examination has approved me to wear a respirator. I have been <br /> trained in the appropriate use, care, and storage of respiratory equipment. I have been <br /> respirator fit tested; and I have my respirator available for use in the field. I further <br /> understand that this equipment is provided solely for my benefit with the intent to minimize <br /> my exposure to potentially hazardous conditions. In the event of such usage, I agree to <br /> indemnify and hold harmless Tait Environmental Systems and all of its employees from and <br /> against any and all losses, demands, claims, liabilities, lawsuits, damages, costs, and expenses <br /> arising, in any way, from the use of the equipment. <br /> Thank you for your cooperation. <br /> Signature Date <br /> Note. This original signed agreement must be submitted to the Tait Environmental Systems Project <br /> Manager to send to the Health and Safety Manager. <br /> \M\tes\safety\h&s.h&s <br /> 11/07/2005 revision 5 20 <br />