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M77111IMPKmI California Class C <br /> ruwthroov netrdcumtraini'g Solutions UST Operator <br /> Facility Specific WarkshK# <br /> The purpose of this worksheet is to document that Class C Operators have been trained at faciFAY-sWft u erSlo ge NSTJ <br /> components. This worksheet must be cpmoleted at the facility where the Class C operator will t4"dung tncerpoeteft Va f <br /> im <br /> by the online course, 'Fueling Station Safety' This worksheet must be completed BEFORE the Class C Op?r24or a;+rmmes rr�u/srs�r ! <br /> responding to emergencies and dispensing <br /> �a regulated substance. C <br /> UST Facility Name�-\C/` 'Tz.,�j (����J�/", -m jgF��o <br /> UST Facility Address '291ca C L IVJ�_ '_'!" s� f— <br /> ave shown the Class C Operator the Emergency Shut-off Switch. <br /> NOTE: The emergency.stop switch shuts off power to alfffrAAisperrsers and fuel pumps- Tle a ate W"is irdlareat <br /> from the"Stop"or-All Stop"button on the point-of-sale(POs)console. The emergency I"switch is regwired by eatweaf foe Cal= <br /> Contact a qualffied petroleum storage system service contractor if you cannot locate the emefgeaef Stop Veftd. <br /> I have shown the Class C Operator the number to use to call the fire department for ibis f3cWly amd posted th s norm d z ferry} <br /> w ovation. <br /> have shown the Class C Operator the list of company people who stiould be notified in an eme-get ,and posted the i&r,a <br /> / c—Visible location. <br /> have shown the Class c Operator the tank monitor and provided insfr,tions on how io resrsF'_4,n—^row's ala m rae=ages tint <br /> may appear on the display. <br /> NOTE If you de not know how to readthe display or what messages to expect if there Is a l rc- + :. - = =--STa)Q spetm <br /> look in the tank monitor manual to find this information or call a quatihed Oetroleem system ccufra�%r :-ave`aKOff eglam ek <br /> information to you. <br /> I have shown the Class C Operator the locations and proper identification of the following ife's! <br /> ❑ Dispenser <br /> ❑ Hose <br /> ❑ Nuzzle <br /> ❑ B , ay Coupling <br /> Egency Shut-off Switch <br /> verfill Alarm(if applicable) <br /> A CLASS C UST OPERATOR MUST BE ON-SITE AT ALL TIMES DURING NORMAL BUSINESS HOURS <br /> I hereby certify I have completed this worksheet together with the Class C Operator: `} <br /> Designated Class A or B Operator Narna: � <br /> Designated Class A or B Operator Signature: <br /> I have completed this worksheet together with the person named above: <br /> Class C Operator Name: <br /> Class C Operator Signature: <br /> KEEP THIS DOCUMENT ON-SITE <br />