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L t I Californi/a� Class C <br /> P0INEIXEa By sollZiti leis UST operator <br /> �Salutians V V <br /> Facility Specific VVorksl eei <br /> The purpose of this worksheet is to document that Class C Operators have been trained on focillty-sppcige npdolgrolmd slulogo hunk(11:1) <br /> components. This worksheet must be compgW_dthe - iib where the Class C Operator will be will king to cdmphdu 11111 Ito 1111111!Inovldod <br /> bythe online course, 'Fueling Station Safety.' This worksheet most be completed REFORL the Class C Opinaho nssunws I"spuedlbdlly I'll <br /> responding to emergeacie6a`nd dispoi!pkt regi a,a Gsubst nee. <br /> UST Facility Name �" USI IacIR <br /> UST Fa Address <br /> Address <br /> ❑ II have shown the Class C Operator the Emergency Shut-oft Switch. <br /> NOTE: The emergency stop switch shuts off power to all the dispensers and fuel pumps. The vnargenoy slop swtteb Is diffmroul <br /> from the"Stop"or"All Stop'button on the point-ol-sale(post console. Tine emelgonny slop switch Is required by 11011111181 lir"Collins, <br /> Contagt a-qualified petroleum storage system service contractor It you cannot locale the emorgoucy step switch. <br /> ❑ shown the Class C Operator the number to use to call the fire depmlinanl for this Inr.ilily and posted this uundmr 1110 rl"N <br /> VIv+hs� <br /> lbvlle location. <br /> ❑ 1 h hewn the Class C Operator the list of company people who should be notified in an mnergeory and pmstod tho libl II <br /> c early visible location. <br /> ❑ I have shown the Class C Operator the tank monitor and provided instructions on how to nspond to valines ninon muse <br /> may appear on the display. <br /> NOTE It you do not know how to read the display or what mdssaecs to expect it genre Is a problem with tho Sun ago nyxtmn, <br /> look in the tank monitor manual to find this information or call a qualified petroleum system contractor and have hhn or tun "globi this <br /> information to you. <br /> I have shown the Class C Operator the locations and proper identificaliou of the following filen& <br /> ❑ Dispenser <br /> ❑ Hose <br /> ❑ <br /> Cy r kaway Coupling <br /> EY, <br /> mergency Shut-off Switch <br /> Overfill 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 work a e} 4th the ClAks cMegh tQl: <br /> Designated Class A or R Operator Name:.._. <br /> Designated Class A or B Operator Signature -- - �� <br /> ,+ ]' i <br /> I have completed this works hee the with th�jr9Fegn abo / <br /> Class C operator Name: <br /> Class C Operator Signature:.._._--------------- <br /> KEEP THIS UOf.UMFNT ON.-SIT[: ATALL T( <br /> 0ur rnrrt,Mr <br />