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loop <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED OPERATOR FACILITY EMPLOYEE TRAIZU iG RECORD <br /> For use by Unidocs Member Agencies or where approved by your Local Jurisdiction <br /> Authority Cited: 77tle 23,Div. 3, Ch. 16 Calirornla Code of Regulations(CCR) <br /> Facility Name: Rancho San Miguel <br /> Facility Site Address: 610 Cherokee Lane City: Lodi <br /> Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators <br /> provide paining to facility employees who have responsibilities associated with the operation and/or maintenance of <br /> underground storage tank(UST)systems.This training must be provided by July 1,2005,and every 12 months thereafter.For <br /> facility employees hired after July 1,2005,the initial training must be provided within 30 days of the date of hire.At least one <br /> of the facility employees present during operating hours must have current training. This training most include, but is not <br /> limited to,the following items as specified in 23 CCR Sections 2715(f)(1)and(2): <br /> ❑ Operation of the UST system in a manner consistent with the facility's Best Management Practices; <br /> ❑ The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; <br /> ❑ The employee's role with regard to spills and overfills as specified is the written UST Response Plan; <br /> ❑ Name(s)of contact persons)for emergencies and monitoring equipment alarms; <br /> ❑ For facilities that are not routinely staffed,facility employee responsibilities as specified in the training program <br /> approved by the local UST regulatory agency. <br /> 23 CCR§2715(f)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank <br /> Operators)be maintained on-site,or off-site at a readily-available location if approved by the local agency; and provided to <br /> the local agency upon request.Completion of this form will satisfy UST training record keeping requirements.The following <br /> employees have been trained as required by 23 CCR Sections 271.5(f)(1)and(2): <br /> Facility Employee Name Training Date Hire Date' Trainer Name <br /> Denise Davila 2/9/07 7/1/04 David L. Martin <br /> Benny Perez 2/9/07 7/1/95 David L. Martin <br /> (Continued on reverse) <br /> if hired after July 1,2005, <br /> 'Trainer must be a current Designated UST Operator for the facility at the time of training. <br /> UN-061-1t2 www.uaidocs.org 07/17105 <br /> L00/100 'd 00iOBHE Z 'ON XVH 'HM SS31 H03 0003 KV 6; :L0 QHM/LOOU/ I/HHH <br />