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I- "'t — vG. nev. 03Q20CF JUN 2 2 2015 UST Facility ID Training Date OPERATORS -7 3 2, OF SOUTHERN GLIFORNIA ENVIRONMENTAL ,r-�1 TMJ ryr.-.ti ^TSr�Ct1tT Training Acknowledgement Form "Facili Employee" UST Compliance Refresher Training Facility Employee (FE) Name Facility Name and Address 'P1 L,o*V' / �t,y LI-� C, J (a 17 LG k op TF--�oti FT S Gi 1 �T kIvi� Loo t . /A E Facility Employee (FE) Underground Storage Tank (UST) Compliance Refresher Training Review FE Initials if Reviewed Compliance Expectations DO has Reviewed with FE 1. 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 il-VI spill. The FE can locate emergency contact information and can explain that any environmental alarms or spills require a response and resolution. /1 3. The FE can demonstrate he/she can properly complete entries to the Monitoring System Daily Check (Alarm History) Form /!1 and can verbalize the purpose of the form 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. r 6. The FE can explain the purpose of the Designated Operator (DO) and what the facility is expected to do to respond to a �V 1 DO finding on the DO's monthly Visual Inspection Checklist (VIC). 7. The FE can explain the purpose of the facility's Monitoring Plan and can demonstrate knowledge about periodic fcompliance i testing requirements. + 8. The FE can explain the purpose of the facility's Release Response Plan and can demonstrate knowledge about spill/leak �f response ('worst case discharge" and "most likely discharge") including completing the facility's Spill Log. V 9. The FE can indicate the location of emergency shut off switches and explain when they should be used. The FE can '1 indicate the location of the facility's spill response kit(s) to be used in the event of a spill. 10. The FE can explain how long tank system -related testing records and other documents should be kept by the facility (minimum three years in the binder or records repository, five years on site, for the lifetime of the tanks offsite). 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 (COPA) enforcing these regulations at my facility. I understand and accept the duties and responsibilities that I am expected to perform with regard to my facility's 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 I 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 idance wit Instructions provided to me by the COPA having jurisdictiQr(�ja{ rr�y tation. � / Facility Employee Name (Please Print FE Signature and Date Trained by: Lance York 5296385 -UC / Sept. 1, 2014 Facility DO Name DO S' n ture, International Code Council (ICC) Certification # k4ation of re reshertraining and Expiration Date