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Site Safety and Health Plan 1 rerracon <br /> ±19.41 Acres Vacant Land ■ Manteca, California <br /> June 12, 2017 ■ Terracon Project No. N8177049 <br /> ACKNOWLEDGMENT OF INSTRUCTION <br /> I understand this project involves the excavation of soils impacted by petroleum hydrocarbons. I <br /> have read this Safety and Health Plan and have received instructions for safe work practices, <br /> personal protective equipment and air monitoring requirements. I further understand that if I <br /> encounter unanticipated contamination or site conditions I am to leave the site and immediately <br /> notify the Project Manager and Corporate Safety and Health Manager of the conditions observed. <br /> PROJECT NAME: ±19.41 Acres Vacant Land, APN 221-210-020, Manteca, San Joaquin <br /> County, California <br /> TERRACON JOB #: NB177049 <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): <br /> AIR MONITORING RESULTS (Attach separate page if required.) <br /> terra con . cornI rerracon <br />