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2-11-19% 10: 17AM FROM ART INC. 9164319360 P- 6 <br /> %MW *40 <br /> STANDARD SITE-SPECIFIC <br /> HEALTH & SAFETY PLAN ACKNOWLEDGEMENT <br /> INSTRUCTIONS:This form is to be signed by all on-.Site BRADLL'y&kMROVAf iVTAL SERVXf FS penonwt including visitors.prior to <br /> work beginning. Any changes to the conditions at the site or the work to be performed requires a new Site 1'pecifec Health and Safety Plan to he <br /> prepared and approved and its accompanying Aclaiowledgemenl sheet to be sigm'd as required. <br /> 1. CLIENT INFORMATION <br /> Client Name_, DE11F1 V(FCATIONAI-CLNTER (DIVISION OF THE STATE ARCHIT$CHT) <br /> Addrea 23500KASSONRnnn TRACY CA 95376 — <br /> Standcad Safcty!k.Health Plan Date. 1130/98 <br /> 2. ACKNOWLEDGEMENTS <br /> I acknowledge ibat 1 have received and read the attached Site-Specific Health and Safety Plan fbr the aforementioned client site. 1 also certify to the <br /> Mat of my knowledge this plan reflects the current work to be performed and the ha.�atds present Fay signing below,I agree to abide by tie:all <br /> pn etidurcs awyot in$tructitms contamod in the plan and tclatod BRADLEY FN V IF.UNMENTAI.SF.R V ICES Standard Operaticmc Prucadures and <br /> I am ready to perfbim the work safely with the materials requited. <br /> Nam(Print) Signature Tide Date <br />