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JUn 7 2006 12:37 FROM:CIRCLE K 0584116 <br /> T0: 19512705121 P. 10�11 <br /> CALiJRNIA ON-SITE STATION TRAEVIN`dORM <br /> Site Number. <br /> Manager Name !�/L <br /> Street Address__Z�7p f AlL / ,p <br /> U�! <br /> City, Zip Code_ jl�y� y� `C >>t <br /> Employee Name (Print) <br /> I acknowledge that I have r ceived and understand environmental compliance training in <br /> the following areas lease initial): <br /> Initial Date <br /> Welectronic <br /> O erations <br /> and locations of the tanks at the station b <br /> nic monisdil rin check to and alarm toonic monitors who to call in the event of an alarm <br /> Materials Mana azardous Materials Mana ement/Business P12 <br /> . terials at the station are hazardous <br /> 2. Where these materials are stored <br /> 3. How these materials are to be handled,stored, and di osed of <br /> 4. What Material Safety Data Sheets SDS are and where they are kept at the station <br /> 5. Training topics included in the HMMP, including review of MSDSs and the emergency <br /> response plan <br /> Waste Management Procedures <br /> 1. The correct management for products in the station <br /> 2. Proper labeling of wastes <br /> 3. The importance of manifesting or having a receipt for all hazardous materials that leave the <br /> NLocation <br /> ersonnel are not to si hazardous waste manifests <br /> Leak Res—se Sill Res onse Plan <br /> on of s ill res onse a ui ment <br /> on of s ill or leak contact list,re ortin rocedures <br /> n of emer enc fuel sh -offswitch <br /> Reconciliation <br /> erform accurate fuel inventory control <br /> 2. Follow-up of gasoline invento overage/shortage variance <br /> 3. Reporting and maintaining inventory records and fuel delivery receipts <br /> Daily Self Inspection* <br /> 1. Type and operation of vapor recovery equipment at the facility <br /> 2. How to perform daily inspection of equipment <br /> 3. Procedures for noncom liance a ui men[ (tag out of order), com Tete maintenance to <br /> Record Keeping (Maintenance, monitor, testing, wastes, inspections, inventory, perimifs, trainin , etc <br /> 1. Location where records are kept <br /> 2. Types of records maintained at the facility/length of time each record should be kept <br /> OZ.a cclr �' 64�1_crr <br /> —ingbyee Signature Soc. Sec. #or Emp. ID# D ate <br /> Training Performed Hy G�r`c ✓u , SZ 1$51�,ti� (, �t,s <br /> Designated Operator Name Certificate# D ate <br /> ' For facilities within the jurisdiction of the South Coast Air Quality Management District, the training provided to <br /> employees must be certified by the agency. <br /> MAINTAIN THIS FORM THE ENTIRE TIME THE EMPLOYEE WORKS AT THE FACILITY 00982 2/05 <br />