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1 � <br /> i � <br /> HEALTH.& SAFETY PLAMACCEPTANCE FORM <br /> 1 <br /> INSTRUCTIONS: This form is to be completed by each PSC employee working <br /> on the project site. <br /> 1 <br /> Project Name: Soil-Vapor Intrusion Survey <br /> 1 Project Location: Former Colombo/Toscana Bakery <br /> 1444 South Lincoln Street in Stockton,CA 95206 <br /> 1 Stockton,CA 95206 <br /> Project Number: 62403335/254512 <br /> 1. Date: January 30,2009 <br /> I represent that I have read and understand the contents of the above Plan and <br /> agree to perform my work in accordance with it. I further more acknowledge that <br /> I have been made aware of OSHA Hazard Communication Requirements for this <br /> project and Department of Labor Postings. <br /> 1 <br /> S�12t7✓i�fh/ W[Lbc-72 C / %f.P'.e��L;im N�'l e& IL 42 <br /> 1 Print Name ] Signed\.� Date <br /> �. vj � � `� f 130 /0 <br /> 0 /0 `I <br /> Print Nam Signe ate <br /> Print Name Signed Date <br /> 1 <br /> Print Name Signed Date <br /> Print Name Signed Date <br /> Print Name Signed Date <br /> Print Name Signed Date <br /> 1 <br /> Print Name Signed Date <br /> 1 <br />