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UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD <br /> For we by Undoes Member Agencies or where approved by your Local Jurisdiction <br /> Authority Cited. Title 23,Div.3, Ch. 16 California Code of Regulatiom(CCR) <br /> liacility Name; - <br /> Facility Site Address: _-Ltt9 7/ Y td W Ci Lo bb� <br /> Section 2715 of Title 23, California Code of Regulations, requires drat Designated Underground Storage Tank Operators <br /> provide paining to facility employees who have tesponsibilities associated with the operation and/or maintenance of <br /> underground storage tank (UST) systems. This training must be provided by July 1, 2005, and every 12 months thereafter. <br /> For facility employeeshired after July 1, 2005, the initial training must be provided within 30 days of the date of hire. At <br /> least one of the facility employees present during operating hours must have cturent trainutg.'i'ltis trainrrtg gm include but <br /> is not limited to,the following items as specified in 23 CCR Sections 2715(f)(1)and(2): <br /> Pf Operation of the UST system in a manner consistent with the facility's Best Management Practices; <br /> 1$ The employee's role with regard`to UST monitoring equipment as specified in the written UST Monitoring plan; <br /> 11A The employee's role with regard to spills and overfills as specified in the written UST Response Plan; <br /> a'f Name(s)of contact persons)for emergencies and monitoring equipment alarms; <br /> ❑ For facilities that are not routinely staffed,facility employee responsibilities as specified in the training pmgtam <br /> approved by the local UST regulatory agency.. <br /> 23 CCR§2715(f)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank <br /> Operator(s)be maintained on-site,or off-site at a readily-available location if roved by the tocaf,_. grow and provided to <br /> the local agency upon request.Completion of this form will satisfy UST training record keeping requirements Thr;following <br /> employees have been trained as required by 23 CCR Sections 27 t 5(f)(l)and(2): <br /> Facili Em to ee Name Ttmin Date Hire Date Trainer Name <br /> SLAT/IIAN (1 HPNA At <br /> - <br /> fr—q K h 4 N _ <br /> l _ <br /> 14 Q <br /> 6 <br /> t <br /> 'If hued after July 1,2005. <br /> 'Trainer must be a curreta Dmigmted UST-Operator for the facility at the time of tjwging. <br /> UN-e61 -UI wmr.uoidocsarg <br />