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i I <br /> I <br /> == Kraza� n <br /> } <br /> 1 <br /> } <br /> KRAZAN & ASSOCIATES,INC. <br /> HEALTH AND SAFETY PC-AN <br /> FIELD PERSONNEL RELEASE FORM r <br /> I, •, � <br /> do hereby confirm that I have read and understand the health and <br /> + safety plan for Project Number 034-98081, H&H Engineering located at 212 Industrial Drive in Stockton <br /> California. I do agree to follow this plan, and to make every effort to make the work place safe. I will report Ir <br /> t I <br /> any health or safety hazard that I observe to the Safety Task Leader, Project Safety Officer, or the Project <br /> l.' I <br /> Director. <br /> Ido agree to defend, indemnify, and hold harmless Krazan & Associates, Inc., its owners, <br /> employees, representatives,clients, and the property owner for any accidents, sickness, or injuries resulting <br /> from the violation, alleged violation, or non-compliance of this Health& Safety Plan. <br /> f <br /> i <br /> ` Name: Title: <br /> 5 <br /> Signature: Date: <br /> { �,` <br /> • Y <br /> f <br /> j <br />