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6 <br />we: OJi;:iX,U� <br />UST Facility Training Date <br />UM <br />OPER""s JUN 2 2 2015 <br />Training Acknowledgement ement Form`°IRONMENTA! <br />J V Tr,j rnrpii0 rgACm <br />"Facility Empiovee" UST Compliance RE <br />r 1 T . . <br />r .I <br />Facility Employee (FE) Underground Storage Tank (UST) Compliance Refresher Training Review <br />RemAewad <br />Compiarwa EmgmeaaDOM DO has Revie red with FE <br />t —Th.—FE can explain how the facility's underground storage tank system is monitored — tanks, product lines. tank top sumps <br />V <br />and under -dispenser containment (UDC). <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 spins require a <br />response and resolutlon. <br />3. The FE can demonstrate he/she can property complete entries to the Monitoring System Daily Check (Alarm History) Form <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 UST system with visual and audible alarm capabilities. <br />_ <br />4. The FE can demonstrate helshe can properly complete entries to the Alarm Response Log using provided alarm examples <br />verbalize the purpose of the form The FE acknowledges any enviro�neeta! monitoring system alarm must be <br />log ed into the Alarm Response Log along with details concerning thesodubon of the alarm. <br />_Zed <br />5. The FE can And the UST compliance records repository used by the facility and can locate the facikty's current Monitoring <br />System Certification. <br />6. The FE can explain the purpose of the Designated Operator (DO) and what the facility u 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 factfty's Monitoring Plan and can demonstrate knowledge about periodic <br />compliance tasting requirements. <br />8. The FE can explain the purpose of the facility's Release Response Plan and con demonstrate knowledge about spill/leak <br />response ('worst rase discharge" and "most likely discharge") including completing the facility's Spill Log. <br />9. The FE can indicate the location of emergency shut off switches and explain when they should be used. The FE can <br />Indicate the location of the facility's spill response kit(s) to be used in the event of a spill. <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 offsde) <br />Facility Employee Acknowledgement: <br />The Designated Operator for my facility, identified Wow, 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 Calitornis's LIST 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 lank pad, contacting identified emergency contacts In the event of a spill or <br />release of product and the proper documentation of these activities. <br />1 have asked any questions I may have had concerning these expectations until 1 was Wood I underoland that 1 am <br />-.0 <br />responsible in whole or In part for maintaining the required UST compliance documen 1 will ure that these records will <br />be kept m rdance wxh instructions provided tome by the CUPA having jurisdiGi <br />Amy <br />t.m0c1 h- .,g7 <br />Facility Employee Nang (Please Pri FE Signature and Dale <br />Trained by: <br />Lance York 5296385 -UC ! Sept. 1, 2014 <br />Facility DO Name O ignature. International Code Council (ICC) Cenification # <br />reinfirmalion4if FF refresher tmininn .ne Fmimhan Mme <br />