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Safety and Health Plan <br /> Vacant Property Tracy, California Irerracon <br /> May 21, 201 Terracon Project No. NA197074B <br /> ACKNOWLEDGMENT OF INSTRUCTION <br /> I understand this project involves the drilling and handling of soils and groundwater potentially <br /> impacted by petroleum hydrocarbons, herbicides, pesticides, and VOCs. I have read this Safety <br /> and Health Plan and have received instructions for safe work practices, personal protective <br /> equipment and air monitoring requirements. I further understand that if I encounter unanticipated <br /> contamination or site conditions I am to leave the site and immediately notify the Project Manager <br /> and Corporate Safety and Health Manager of the conditions observed. <br /> PROJECT NAME: Vacant Property, 23577 S. Mountain House Parkway, Tracy, CA 95304 <br /> TERRACON JOB #: NA197074B <br /> Name (Please Print) Signature Date <br /> PERSONAL PROTECTIVE EQUIPMENT UTILIZED: <br /> LEVEL D LEVEL D MOD. LEVEL C <br /> Safety briefing performed by: Date: <br /> PETROLEUM CONTAMINANT(S), PESTICIDES, HERBICICDES, VOCS: <br /> AIR MONITORING RESULTS (Attach separate page if required.) <br /> Environmentalterra con. com Irerracon <br /> i <br />