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J ( PA Emergency Response Employee Attendance Roster <br /> FFacilityame : _ J f C �TrL ilkSubject : Emergency Response for Emergency Response and Action Plans <br /> READ THE FOLLOWING BEFORE SIGNING <br /> I acknowledge that I have received Emergency Response Training on the subject listed above. During this training, I was made aware of guideline for responding to a fire <br /> or explosion (including use of portable hand -held fire extinguishers) , a release of hazardous materials , natural disasters and facility emergency situations. I was informed <br /> of the facilities evacuation assembly point. I also understand that the facility alone is responsible for environmental and safety issues at all facilities and that, should I have <br /> any questions or concerns on such matters , I should address them to my supervisor. <br /> Printed Name Job Description Signature <br /> 2 <br /> IC <br /> v I—. 2L <br /> wta <br /> C.� � I <br /> 4lC� � <br /> 6 <br /> 1 7 <br /> 9 #MKIC <br /> C .JkIr;:60mae7 nn 6e rl 74 a 16 <br /> 10 S'f'@trt h 7 KAJ\ r(A - <br /> 1 1 141A <br /> 12 7::Yss �- <br /> 13 h <br /> 14 tri ��1• <br /> r�A <br /> 15 co <br /> V 16 <br /> 17 <br /> 18 <br /> 19 oc26 <br /> 20 '�- <br /> 21 - <br /> 22 <br /> 23 <br /> 24 <br /> 25 <br /> 26 <br /> 27 <br /> 28 <br /> 29 <br /> 30 <br /> I certify that I conducted Emergency Respons ning in accordance with Federal and State Requirements with the above listed employee. <br /> KPA Con Fant ( Printed e) Signature Date <br /> Page 1 <br />