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UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD <br /> For use by Unidacs Member Agencies or where approved by your Local Jurisdiction <br /> Authority Cited Title 23,Div. 3,Ch. 16 California Code of Regulations(CCR) <br /> Facility Name: r�� ��r c O PtVI <br /> —� <br /> Facility Site Address: ;ISS (� 1'wn-e, y (,a't k. City: GL d– <br /> Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators <br /> provide training 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. <br /> For facility employees hired after July 1,2005, the initial training must be provided within 30 days of the date of hire. At <br /> least one of the facility employees present during operating haws must have current training.This training must include,but <br /> is not 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 in 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(fx3)requires that a list of employees who have been trained by the Designated Underground Storage Tank <br /> Operator(s)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 2715(fxi)and(2): <br /> Facility Employee Name Training Date Hire Date Trainer Name <br /> A 2 M? 1 S I N 4 19 ` L`t r-, 2- <br /> 3 <br /> I to1)E2 S i+t S L 2s <br /> (Condamed on reverse) <br /> j If hired alter July I,2005. <br /> r Trainer mart be a current Designated UST operarur for the facility at rhe time of Gaining. <br /> UN-061-1/2 <br /> vww.aaidaesors OVUM <br />