Laserfiche WebLink
<br /> <br />5. CONTRACTOR CERTIFICATION OF EMERGENCY <br /> RESPONSE PROGRAM <br /> <br />The Contractor Representative completing this Contractor Qualification Form has <br />reviewed a copy of and been instructed in the Leprino Foods - Tracy Emergency <br />Response Plan. The Contractor Representative acknowledges that they have <br />been instructed to provide this information to all contractor employees prior to <br />their working on the Leprino Foods - Tracy facility and to ensure that each <br />employee understands the applicable required procedures. <br /> <br />Initials of Contractor Representative: _________ <br /> <br /> <br />6. STATEMENT OF TRUTHFULLNESS AND ACCURACY <br /> <br />The undersigned certifies that all answers provided in completing this form are <br />true and accurate to the best of their knowledge. <br /> <br />Date: <br /> <br /> <br />Print Contractor Representative Name: <br /> <br />I have reviewed the information provided and the contractor is:  Qualified  <br />Not Qualified: <br /> <br />Date: <br /> <br />Leprino Foods - Tracy Representative Print Name: <br /> <br /> <br />ANNUAL RECERTIFICATION Date: _____________________________ <br /> <br />The undersigned certifies that all answers remain the same except for changes <br />as noted and initialed, and that the answers are true and accurate to the best of <br />their knowledge. <br /> <br />Print Contractor Representative Name: <br /> <br />I have reviewed the information and the contractor is:  Qualified  Not <br />Qualified: <br /> <br />Leprino Foods - Tracy Representative Print Name: <br /> <br />