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PERATORS M11 <br />JUN 2 2 2015 -� 3 Z� r <br />OF SOUYNENN GLIFORNIA <br />I!qpNMENTAL <br />Training Acknowledgement Fortt"'�°'¢T"P��tT <br />"Facilitiv Em to ee" UST Com liance Refresher Training <br />TrainingFacility Employee (FE) Name Facility Name and Address Initial Date <br />IG "0 <br />Glp O A N t01 q I �a Z <br />N <br />UndergroundFacility Employee (FE) ... <br />FE Initials if <br />Reviewed <br />Compliance Expectations DO has Reviewed with FE <br />,j �' <br />1. The FE can explain how the facility's underground storage tank system is monitored — tanks, product lines, tank top sumps <br />I.j <br />IP <br />and under -dispenser containment (UDC). <br />i <br />2. The FE can explain their roles and responsibilities at the facility in reacting to a facility monitoring system alarm, leak or <br />spill. The FE can locate emergency contact information and can explain that any environmental alarms or spills require a <br />response and resolution. <br />3. The FE can demonstrate he/she can properly complete entries to the Monitoring System Daily Check (Alarm History) Form <br />/ <br />and can verbalize the purpose of the form is to document daily verification that the facility's monitoring system is <br />continuously monitoring the USTsystem with visual and audible alarm capabilities. <br />4. The FE can demonstrate he/she can properly complete entries to the Alarm Response Log using provided alarm examples <br />�1 � <br />and can verbalize the purpose of the form. The FE acknowledges any environmental monitoring system alarm must be <br />J: <br />logged into the Alarm Response Log along with details concerning the resolution of the alarm. <br />5. The FE can End the UST compliance records repository used by the facility and can locate the facility's current Monitoring <br />fSystem <br />Certification. <br />6. The FE can explain the purpose of the Designated Operator (DO) and what the facility is expected to do to respond to a <br />DO finding on the DO's monthly Visual Inspection Checklist (VIC). <br />7. The FE can explain the purpose of the facility's Monitoring Plan and can demonstrate knowledge about periodic <br />{ <br />compliance testing requirements. <br />i <br />8. The FE can explain the purpose of the facility's Release Response Plan and can demonstrate knowledge about spill/leak <br />"most <br />Jresponse <br />("worst case discharge" and likely discharge") including completing the facility's Spill Log. <br />�1 <br />9. The FE can indicate the location of emergency shut off switches and explain when they should be used. The FE can <br />% <br />indicate the location of the facility's spill response kit(s) to be used in the event of a spill. <br />J <br />10. The FE can explain how long tank system -related testing records and other documents should be kept by the facility <br />(minimum three years in the binder or records repository, five years on site, for the lifetime of the tanks offsite). <br />Facility Employee Acknowledgement: <br />The Designated Operator for my facility, identified below, has reviewed with me the expectations noted above concerning my roles and <br />responsibilities in keeping my facility's underground storage tank (UST) system in compliance with California's UST regulations as well as <br />any local requirements of the Certified Unified Program Agency (CUPA) enforcing these regulations at my facility. <br />I understand and accept the duties and responsibilities that I am expected to perform with regard to my facility's Monitoring Plan and <br />Release Response Plan. These include implementation of facility best management practices, response to monitoring system alarms, <br />response to spills at the fueling islands or overfills at the tank pad, contacting identified emergency contacts in the event of a spill or <br />release of product and the proper documentation of these activities. <br />I have asked any questions I may have had concerning these expectations until I was satisfied I understood them. I understand that I am <br />responsible in whole or in part for maintaining the required UST compliance documents for my station. 1 will ensure that these records will <br />be kept in7o dance wit instructions provided to me by the CUPA having jurisdicti A r9 tation. ,✓ � <br />17 <br />Facility Employee Name (Please Print FE Signature and Date <br />Trained by: <br />Lance York 5296385 -UC / Sept. 1, 2014 <br />Facility DO Name DOSenture, International Code Council (ICC) Certification # <br />o imiation offresher training and Expiration Date <br />