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HEALTH AND SAFETY PLAN APPROVAL/SIGNOFF FORM <br /> Site Name: Pelp $0y:5; 5-;-e,r e 7I! w0# <br /> Address: tU<2 - <br /> I understand, agree to and will conform with the information set forth in this Health and Safety Plan (and attachments)and discusses <br /> —+ in the Personnel Health and Safety briefing(s). <br /> Name Signature Date <br /> y <br /> r <br /> v <br /> w <br /> r <br /> .r <br /> r <br /> r <br /> v <br />