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Mil. WMA PA7 <br /> FAN F <br /> APPENDIX A <br /> CERTIFICATION AND ACKNOWLEDGMENT STATEMENT <br /> SAFETY PIAN CERTIFICATION <br /> All Golden Grain Company authorized project personnel and <br /> subcontractor personnel are required to make the following <br /> certification prior to conducting work at the Manteca Bean <br /> Facility, located at 229 Moffat Boulevard, Manteca, California. <br /> of <br /> i, <br /> NAME <br /> certify that: <br /> COMPANY <br /> 1, I have read and fully understand the health and Safety Plan <br /> and my individual responsibilities. <br /> r <br /> 2 I agree to abide by the provisions of the Health and Safety <br /> Plan. <br /> SIGNATURE <br /> DATE <br /> GROUNDWATER <br /> T6CHICOLOGY,INC. <br />