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27 <br />ACKNOWLEDGMENT FORM <br />I have received /obtained the Waste Industries "Safety Policy and Procedures Manual," which <br />outlines basic safety practices and minimum safety standards as required by the company and regulatory <br />compliance, I hereby acknowledge that I will read and utilize the information contained in the Manual and <br />have been offered an opportunity to ask questions and seek clarification when necessary. <br />I understand that changes occur in our working environment that could cause amendments, <br />deletions or additions to these guidelines. I further understand that as a member of management, that <br />although I may delegate various responsibilities under this policy and procedures manual, I am ultimately <br />accountable for their application, and that accountability may not be delegated or transferred. <br />Management Signature Date <br />NOTE: <br />The Safety Policy and Procedures Manual is the sole property of Waste Industries USA, Inc. This manual <br />and all others dealing with company policy, standards of practice, rules and regulations, will not be altered, <br />reproduced or distributed in any form without the expressed permission of Risk Management and /or the <br />Vice President of Operations. <br />Waste Industries Home Office <br />3301 Benson Drive, Suite 601 <br />Raleigh, North Carolina 27609 <br />