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' V Rev. aAvzooe V UST Facility ID Training Date OPERATORSIN (o l7 vaw.� ai...... JUN 2 2 2015 Training Acknowledgement Form,, VIRONMENTAI_ "Facility Employee" UST Compliance Refresher Traininq 0 'Pt L"OT -FLY I Ii.� 3 -tom 1p t'1 Facility Employee (FE) UndergrOLInd Storage Tank (ILIST) Compliance Refresher Training PeJejv FE t>",11 it FbNWwed CompAarm Expeciladons DO has Reviewed wO FE t. The FE can explain how the facility's underground storage tank system is monitored — tanks, product lines, tank top sumps and under -dispenser containment (UDC). 2. The FE can explain their roles and responsibilities at the facility in reacting to a facility monitoring system alarm, leak or spill. The FE can locate emergency contact information and can explain that any environmental alarms or spills require a response and resolution. 3. The FE can demonstrate he/she can properly complete entries to the Monitoring System Daily Check (Alarm History) Form and can verbalize the purpose of the forth is to document daily verification that the facility's monitoring system is continuously monitoring the UST system with visual and audible alarm capabilities. 4. The FE can demonstrate he)she can properly complete entries to the Alarm Response Log using provided alarm examples and can verbalize the purpose of the form. The FE acknowledges any environmental monitoring system alarm must be logged into the Alarm Response Log along with details concerning the resolution of the alarm. 5. The FE can find the UST compliance records repository used by the facility and can locate the facility's current Monitoring System Certification. 6. The FE can explain the purpose of the Designated Operator (DO) and what the facility is expected to do to respond to a DO finding on the DO's monthly Visual Inspection Checklist (VIC). l— 7, The FE can explain the purpose of the facility's Monitoring Plan and can demonstrate knowledge about periodic •/,/ )��, compliance testing requirements. B. The FE can explain the purpose of the facility's Release Response Plan and can demonstrate knowledge about spill/leak response ('worst case discharge' and 'most likely discharge") including completing the facility's Spill Log. 9. The FE can indicate the location of emergency shut off switches and explain when they should be used. The FE can indicate the location of the facility's spill response kit(s) to be used in the event of a spill. The FE can explain how long tank system -related testing records and other documents should be kept by the facility (minimum three in the binder or records repository five on site, for the lifetime of the tanks offsite). years years Facility Employee Acknowledgement: The Designated Operator for my facility, identified below, has reviewed with me the expectations noted above concerning my roles and responsibilities in keeping my facility's underground storage tank (UST) system in compliance with California's UST regulations as well as any local requirements of the Certified Unified Program Agency (CUPA) enforcing these regulations at my facility. I understand and accept the duties and responsibilities that I am expected to perform with regard to my facilitys Monitoring Plan and Release Response Plan. These include implementation of facility best management practices, response to monitoring system alarms, response to spills at the fueling islands or overfills at the tank pad, contacting identified emergency contacts in the event of a spill or release of product and the proper documentation of these activities. I have asked any questions I may have had concerning these expectations until I was satisfied 1 understood them. I understand that I am responsible in whole or in part for maintaining the required UST compliance documents for my station. I will ensure that these records will be kept i 7tdance with instructions provided to me by the CUPA having jurisd ctio over my station. Fac Employee Name (Please Print) FE Signature and Date Trained by: Lance York 5296385-UC/Aug. 12, 2016 Facility DO Name 1604griature. International Code Council (ICC) Certification f confirm Ion FE refresher training and Expiration Date M