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0 0 <br /> FORM AF1 <br /> EMPLOYERS CONFINED SPACE ENTRY CERTIFICATION <br /> AND SAFETY TRAINING OF EMPLOYEES <br /> To: Owner of underground storage tank designated below. <br /> Contractor's Name: <br /> Address: CityState Zip <br /> Person in Office Responsible: <br /> Phone: <br /> Location of Work: <br /> Contracting Company(Owner): <br /> Address: City State Zip <br /> Phone: Person Authorizing Work <br /> Address of Work: <br /> City: State Zip <br /> Site Phone: Tank Size: <br /> Contractor's Authorization: <br /> Alternate qualified person(Supervisor): <br /> The above employees are qualified personnel,designated by the employer listed above as capable by <br /> tragi of anticipating, recognizing, and evaluating employee exposure to hazardous substances or <br /> other unsafe conditions in a confined space. <br /> The personnel are knowledgeable of the Material Data Safety Sheet disclosures as described in <br /> section A5. 1.7 of Chapter A on all applicable materials that may be used performing the work <br /> described in NLPA 631 and are capable of specifying necessary control and/or protective action to <br /> insure safety. <br /> I do hereby swear and attest that the above personnel have been trained and are familiar with <br /> NIOSH (Criteria for a Recommended Standard, Working in Confined Spaces Dec., 1979) and are <br /> knowledgeable of all the safety procedures contained in Chapter A. We/I, the employer, are <br /> maintaining written records of training, including safety drills, inspections, tests, and maintenance. <br /> The records are available for review by the State Implementing Agency or Owner, upon request. <br /> SWORN TO AND SIGNED THIS DAY OF ' 19 <br /> Witness Officer/Owner of Contractor <br /> Witness Title <br /> 24 <br />