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FINAL ACCIDENT PREVENTION <br /> PLAN/SITE SAFETY AND HEALTH PLAN <br /> COMPLIANCE AGREEMENT <br /> Page 1 of 2 <br /> Contract Number: W91238-09-D-0017, DO 0004 <br /> Project Name: Soil Excavation at California National Guard Armory, Lodi, California <br /> The contract for the above project requires the following: that you be provided with and <br /> complete formal site-specific training; that you be supplied with proper personal protective <br /> equipment including respirators; that you be trained in its use; that you receive a medical <br /> examination to evaluate your physical capability to perform your assigned work tasks under <br /> the environmental conditions expected, while wearing the required personal protective <br /> equipment. These things are to be done at no cost to you. By signing this certification, you are <br /> acknowledging that your employer has met these obligations to you. <br /> I have read the California National Guard Armory Final APP/SSHP, understand it and agree to <br /> comply with all of its provisions. I understand that I could be prohibited from working on the <br /> project for violating any of the safety requirements specified in the plan. <br /> Name Date <br /> FORMAL TRAINING: I have completed the following formal training courses that meet OSHA's <br /> Hazardous Waste Operations and Emergency Response (HAZWOPER) requirements, as <br /> defined in 29 CFR 1910.120(e), "Training". <br /> Date Complete <br /> Initial 40-hour training: ` U <br /> 3-day field supervised training: <br /> 8-hour supervisory training: <br /> Annual 8-hour refresher training: <br /> SITE-SPECIFIC TRAINING: I have been provided and have completed the site-specific training <br /> required by this Contract. The Site Safety and Health Officer conducted the training on: <br /> Date I-a-o <br /> RESPIRATORY PROTECTION: I have been trained in accordance with the criteria in the <br /> contractor's/my employer's Respiratory Protection Program. I have been trained in the proper <br /> work procedures and use limitations of the respirator(s) I will wear. I have been trained in and <br /> will abide by the facial hair policy. Respirator Use is Not Anticipated for this Contract <br />