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' HEALTH AND SAFETY PLAN ACCEPTANCE FORM <br /> INSTRUCTIONS: This form is to be completed by each person prior to beginning work at the <br /> subject hazardous waste site THIS FORM IS TO BE RETURNED TO THE CLEAN HEALTH <br /> ' AND SAFETY FILES, PRC ENVIRONMENTAL MANAGEMENT, INC , SAN FRANCISCO, <br /> CALIFORNIA <br /> Job No 044-0162 <br /> ' Project Sampling 817-B-2 <br /> Location NAVCOMMSTA Stockton <br /> ' B m signature below, I acknowledge that I have read and understand the contents of the Health & <br /> Y Y g � g <br /> ' Safety Plan for this project I agree to perform my work in accordance with the plan <br /> ' Signature <br /> rPrint Name <br /> ' Company <br /> ' Address <br /> 1 - <br /> ' Telephone Number <br /> Date <br /> ' cc CLEAN Health and Safety Program Manager, San Francisco <br /> CLEAN Health and Safety Files, San Francisco <br /> 1 <br /> A - 1 <br />