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1EGEIV 1 "a eu.0A012008 • a. OPERATORS JUN 2 2 2015 �'�� 1 Z3 w roosu• uurw•u Training Acknowledgement FormR.ONMENTAt - ,n T�jII=M'` "Facility Emplovee" UST Compliance Refresher Traini 'k» C 7) fes, lia.,,.y f _lrti is,ocS T4�1�..4rt co 1-1 /_ / i I I / I L-0 ]>I . !A / ■ Facilit Employee FE Initials it Reviewed Canpliarce Expectetil" DO has Reviewed with FE 1. The FE can explain how the facility's underground storage tank system is monitored — larks, 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 an 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 Dairy Check (Alarm History) Form and can verbalize the purpose of the form is to document dally 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 property comptete entries to the Alarm Response Log using provided alar examples and can verbalize the purpose of the for. The FE acknowledges any environmental monitoring system alar must be logged into the Alarm Response Log along with details concerning the resolution of the alar t / ; 5. The FE can find the UST compliance records repository used by the facility and con locate the facility's current Monitoring System Certification. 6. The FE an explain the purpose of me 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). 7. The FE can explain the purpose of the facility's Monitoring Plan and can demonstrate knowledge about periodic h compliance testing requirements. 6. The FE can explain the purpose of the facility's Release Response Plan and can demonstrate knowledge about spiltileak 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. 10. The FE can explain how long tank system-reialed testing records and other documents should be kept by the facility .t (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 Califomia'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 perforpn-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 contact in (ire event of a spill or release of product and the proper documentation of these activities. / I have asked any questions I may have had ooneeming these expectations until I was satisfied I understood then . I unde and that I av responsible- in whole or in part for intaining the required (1ST compliance document for my stat n. I will engure that t se records Oil be k90n accordan . insI d' ns p vided to m�'he CUPA having junsd m n over my stall n. Facility Emp yae Na a (Plc Pri Sign ,tureyan ate / / Trained by / 64 Lance York 5296385 -UC / Sep 1, $14 Facildy DO Namenature. International Code Council (ICC) ertificatton rt Mirmati n WFE refresher training and Expiration Date