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1 UNDERGROUND STORAGE TANX SYSTEM DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RE�ORD For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23, Div. 3, Ch, 16 Calitbrnia Code of Regulations (CCR) Facility Name: P'acility Site Address: City Section 2715 of Title 23, California Code of Regulations, requires that Designated Undergroun Storage Provide tTaf1k Operators raining respmtenance of underground storage facility employees who have e tatil: (UST) systems, This responsibilities associated with the operation and/or nltraining must be provided by July 1, 2005, and every 12 months thereafter. For facility employees hired after .July 1, 2005, the initial training crust be provided within 30 days of the date of hire At least one of the facility employees present during operating hours must have current training;. This training must inelu r., but is not limite to, the following itcam as spacilicd in 23 CCR Sections 27150(1) and (2): Operation of the UST system in a manner consistent with the facility's Best Management Practices; The employee's role with regard to UST monitoring equipment as specified in the wrimu US T Monitoring Plan; The employee's role with regard to spills and overfills as specified in the written UST Response Plan; Name(s) of contact person(s) for emergencies and monitoring equipment alarms; © For facilities that are not routinely staffod, facility turnployec responsibilities as specified in the training t)grarrt approved by the local UST regulatory agency. 23 COR. § 271 5(f)(3) requires that a list of cmployccs who have bzcn trained by the ,Designated Underground Storage Tank, Opemtor(s) be maintained on-site, or off-site at a readily -available location if aguroved ky the local agencand provided to the local agency upon request. Completion of this form will satisfy UST training record keeping requirements. Th following employees have been trained as required by 23 CCR Sections 2715(f)(1) and (2): (Conrinued on reverse) ' if nired utter July 1, 2005. x Trainer must be a c:unznt Designated UST Operamr for the Wility at the brae of training rJN-o61- �� www.unidocs.orr ze/z(3 119k)d auod SVS 3,10 y 9L9_C 6860 07/13/05 6T :,:T CT3Z/TT/T9 7-A VO 1 /x-/10 www...••• 7 4 o Gt2n.`r (Conrinued on reverse) ' if nired utter July 1, 2005. x Trainer must be a c:unznt Designated UST Operamr for the Wility at the brae of training rJN-o61- �� www.unidocs.orr ze/z(3 119k)d auod SVS 3,10 y 9L9_C 6860 07/13/05 6T :,:T CT3Z/TT/T9