. . . . . . . . . . . . . . . . . . . . . . . . . Powder Actuated Tools Date . . . .
(MAKE)
Card No. . . . . . . . . . Social Security No. . . . . . . . . . . . . . . . . . . . .
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(NAME OF OPERATOR)
has received the prescribed training in the operation of powder actuated
tools manufactured by
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(NAME OF MANUFACTURER)
Model(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trained and issued by
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(SIGNATURE OF AUTHORIZED INSTRUCTOR)
I have received instruction in the safe operation and maintenance of
powder actuated fastening tools of the makes and models specified and
agree to conform to all rules and regulations governing that use
Date of Birth . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(SIGNATURE)
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