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1 . 2 ACKNOWLEDGMENT <br /> I acknowledge having reviewed this Site -Specific Health & Safety Plan ; understand its contents ; <br /> have been afforded the opportunity to ask questions and have them answered ; and agree to <br /> abide by it . Additionally, I am current in the training and medical surveillance requirements <br /> specified in 8 CCR § 5192 , Hazardous Waste Operations and Emergency Response . <br /> (Please Print Clearly) <br /> NAME / SIGNATURE DATE COMPANY AFFILIATION <br /> i <br /> 1 . <br /> _. ....ON................_.................._....._._......................_.....................................IN,............................... ..................................................._.... ._.......-- —...........I..........__............ — ............_....................._.................__........................_................_-............................_.... <br /> 2 . <br /> .....—.__...........OWN--WON.........................NEW................_.._WON......................................._................-................................._......................_.._ ._..._.. ........_..__..__.........ONE..............................._ ...I'D.............ON.............................""..___................NEW._..............ONE................_............._..I <br /> 4 . <br /> ..................._..............................__.._............._....._.........._........................._....._......---OWN..........._'WEE_..........Off,........................... ..................................._._........................................_.._.. ..........._........................._.........................................IN"._........................................................ <br /> 5 . <br /> — .........__. ._......................_......................._.............................................._............_.............................I........................._.._ _....__................_........_.................................................. �..........................................................................................................._.................................... <br /> 6 . <br /> .........NONE......_............_III..................._.........__...OWN..................._.................................____....__._............WIN......_.......-................... 1'—'--..._._......-- ..........._......._.._._ I'll_........_. .................Off,...................................................................._144.411....4..........4............. <br /> 7 . <br /> ......._..__.....—._..........._._..__._...—....._...................— ......._OWN................NONE_._....................-. ..................................._"................................................. ......................................................................................__........_..._...._................................ <br /> 8 . <br /> ...... ..__._.......... _.._.........._ .._........._......................__..........._ .......... ................_ .............. .........................._ _. . . . —— . ...__. . ......... <br /> 9 .. . .. .. . _..... <br /> _...................................................................III.........................__............................Off..._................... ........._........................._.............................................NEW. ............. _.. ......._......... ........_ __..........---. _.........._.........._._...._............. <br /> 10 . <br /> .._.._ __.....__..................._................_......._-IN---............................................................_........_..._..............__...................._ ......................................................................................... ............................_.......................................................................................................ONE.......... <br /> 11 . <br /> i <br /> 12 . i <br /> ...........................................................................".................................._...........................................___._................................................ ......_.III......off_WINE. __.............................................. .........................._.._...................... _........................_._.__.................................._.._.. <br /> 13 . <br /> ......._........._..._.........._.. ...__........"WE_.............._._......................----..._........_...,...111_...._1...................._ _.._......................... _._...................................._........ ..........._._.—........._.......---_................._........1__1_11....._._...........-- <br /> 14 . <br /> ................._................................................................................................................................................................... . ---- - ----'--......--..............................__............ ............................................................... ................__........................ONE..._.................... <br /> 15 . <br /> ............................_........................................................................ONE........................................................._..........................III..._._................_..... .........................................................END.........................NEW. ............-.. _...... ................................._ ..................._........_..__.................................. <br /> 16 . <br /> ON...................__..........._.............................. ........._... .".........._......................................................................................_..............._.... .....--._-..........._......................................OPEN............... ............._...................................................................... ._...............__....._...........4.......ONE <br /> 17 . <br />