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ACKNOWLEDGMENT OF INSTRUCTION <br />I understand this project involves the excavation of soils impacted by TPH, VOCs, SVOCs, OCPs, <br />and metals. I have read this Safety and Health Plan and have received instructions for safe work <br />practices, personal protective equipment and air monitoring requirements. I further understand <br />that if I encounter unanticipated contamination or site conditions I am to leave the site and <br />immediately notify the Project Manager and Corporate Safety and Health Manager of the <br />conditions observed. <br />PROJECT NAME: Proposed Distribution Center <br />5110 and 5290 East Mariposa Road and <br />4522 and 4600 East Marfargoa Drive <br /> Stockton, San Joaquin County, California <br />TERRACON JOB NO: NA227001 <br />Name (Please Print)Signature Date <br />_____________________________ ________________________________________ <br />_____________________________ ________________________________________ <br />_____________________________ ________________________________________ <br />_____________________________ ________________________________________ <br />_____________________________ ________________________________________ <br />_____________________________ ________________________________________ <br />PERSONAL PROTECTIVE EQUIPMENT UTILIZED: <br />_____LEVEL D _____LEVEL D MOD. ____LEVEL C <br />Safety briefing performed by: ___________________________________ Date:_________ <br />AIR MONITORING RESULTS (Attach separate page if required.)