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Ground Zero Analysis, Inc. <br />HEALTH AND SAFETY PLAN <br />SIGN -OFF PAGE <br />I have read the Health and Safety Plan and fully understand the hazards associated with the <br />following job: Olivarez Property #1086 <br />I will comply with the minimum safety requirements set forth in the Health and Safety Plan. I <br />agree to notify the responsible employee of GZA should any unsafe acts be witnessed by me <br />while I am on this site. <br />PRINT NAME SIGNATURE DATE <br />PAGE 11 <br />