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UNDERGROUND STORAGE TANKSYSTEM RECEIVED <br /> DESIGNATED OPERATOR FACILITY EMPLOYEE TRAININVLM1 ORD <br /> For use by Unidocs dlenlber Agencies or where approved by Your Local Jurisdiction 2009 <br /> Authority Cited: Title 23, Div. 3, Ch. 16 California Code ofRvgrlations(CC <br /> SCY <br /> Facility Name: '7 - It t 32,1 10 OFFICEOFEM EMERGENCY SERVICES <br /> Facility Site Address: 09V3 S. �v 9q City: rAvk6,t C4 <br /> Section 2715 of Title 23. California Code of Regulations. requires that Designated Underground Storage Tank Operators <br /> provide training to facility employees who have responsibilities associated with the operation and/or maintenance of <br /> underground storage tank- (UST) s)stems. This training must be provided by July 1. 2005, and evet3 12 months thereafter. <br /> For facility employees hired 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 current training. This training must include, <br /> but is not limited to,the following items as specified in 23 CCR Sections 2715(f)(1)and(2): <br /> Q Operation of the UST system in a manner consistent with the facilit)'s Best Management Practices; <br /> 13 The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; <br /> Ef The employee's role with regard to spills and overfills as specified in the written UST Response Plan; <br /> IT Name(s)of contact person(s)for emergencies and monitoring equipment alarms; <br /> ❑ For facilities that are not routinely staffed, facility-employee responsibilities as specified in the training program <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 Tanis <br /> Operator(s)be maintained on-site,or off-site at a readily-available location if approved by the local agency. and provided to <br /> the local agency upon request. Completion of this form will satisfy UST training record keeping requirements. The <br /> following employees have been trained as required by 23 CCR Sections 2715(f)(1)and (2): <br /> Facility Employee Name Training Date Hire Dater Trainer Name1 <br /> /�1to <br /> ` 5 2 - /Is -vcA J: S. (. u <br /> 1g0X r r.'t S/moi C46 _ , <br /> 5v� G a I t Gloi B or le <br /> / �a ,o/zr/oa to „/os <br /> Ca. /,9'// alio aG <br /> If(Continued on reverse) <br /> 1 <br /> \ 'Ifhired after Tulp t.2005. <br /> Trainer mat be a current Designated i.IST Operator for the facility at the time oftraining. <br /> UN-061-I/2 %vw.unidocs.org 07/13/05 <br />