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Jun 12 U[ W:11p Arco AMF'M ZVW05Lj0ZW p.Z UNDERGROUND STORAGE TANK SYSTEM DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD For use by Unidocs Member Agencies or where approved hy)vur Local Jurisdiction RECEIVED Authority Cited: Title 13, Div. 3, Ch. 16 California Code of ftulalions(CCR} m � �� O 7- JUN 12 2Q[�' Facility Name: h �= � �� SAN��ulN—MNTY / OFFICE OF EMERGENCY SERVICES Faeility Site Address: � y �, City: Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Slorage Tank Operators provide training to facility employees who have responsibilities associated with the operation and/or maintenance of underground storage tank(UST)systems.This training must be provided by July 1,2005,and every 12 months thereafter.For facility employees hired after July 1,2005,the initial training must be provided within 30 days of the date of hire.At least one of the facility employees present during operating hours must have current training. This training must include, but is not limite to,the following items as specified in 23 CCR Sections 2715(fx l)and(2): Operation of the UST system in a mariner consistent with the facility's Best Management Practices; The employee's role with regard to UST monitoring equipment as specified in the written LIST Monitoring Plan; The employee's rale with regard to spills and overfills as specified in the written UST Response Plan; Narne(s)of contact person(s)for emergencies and monitoring equipment alarms; For facilities that are not routinely staffed, facility employee responsibilities as specified in the training program approved by the local UST regulatory agency. 23 CCA§2715(f)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank Operator(s)be maintained on-site,or off-site at a readily-available location if auuroved by the loca)aaencyi and provided to the local agency upon request.Completion of this form will satisfy UST training record keeping requirements. The following employees have been trained as required by 23 CCR Sections 2715(f)(1)and(2): Facili Employee Name Training Date Hire Dater T iner Nstne, RAd 7 As ' 4 KAV e_ y r a f t (Continued on reverse) 'If hired oflsr Julv 1,2005. 'Trainer must be a cumni Designated UST OpertMa for the facility at the time of training UN-961-Il2 www.unidocs.org 07113/05