vi
( ) D. In lieu of the proceeding training requirements, the operator(s)/maintainer(s) is
(are) under the control of a supervisor trained in accordance with _______________
(circle one) above.
I agree to provide ____________________ (telco’s name) with proper documentation
to demonstrate compliance with the information in the preceding paragraph, if so
requested.
_____________________ Signature
_____________________ Title
_____________________ Date
Subscribed and sworn to before me
This _________ day of ___________________, 20__
_______________________________________
Notary Public
My commission expires: _________________________