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• Ll UNDERGROUND S'T'ORAGE TANK SYSTEM DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING &'.ECO For use by Undoes Member Agencies or where approved b}. your Local.lurisdiction duthorityCited- 77de 23, Div. 3, Ch. 16 California Code of Regulations(CCRr Faeiiit:, Name: M i X a,,, ' i Ai/1 vt Facility Site Address: �� 7J� rt_9 r� ( City: Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators provide training to facility employees who have responsibilities associated with the operation and/or maintenance of underground storage rank (UST) systems. This training must be provided by July 1, 2005, and every 12 months thereafter. For facility employees hired after July I, 2005, the initial training must be provided within 30 days ofthe date ofhire. At least one of the facility employees present during operating hours must have current training. This training must include, but is not limited to. the fallowing items as specified in 23 CCR Sections 2715(1)(1) and (2): �•' Operation of the UST system in a manner consistent with the facility's Best Management Practices; The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; The employee's role with regard to spills and overfills as specified in the written UST Response Plan; �h Name(s) of contact person(s) for emergencies and monitoring equipment alarms; $' For facilities that are not routinely staffed, facility employee responsibilities as specified in the training program approved by the local UST regulatory agency. 23 CCR y 2715(f)(3) requires that a list of employees who have been trained by the Designated Underground Storage Tank Operator(s) be maintained on-site, or off-site at a readily -available location if a611roved by the local agency, and provided to the local agency upon request Completion of this form will satisfy UST training record keeping requirements. The following employees have been trained as required by 23 CCR Sections 2715(f)(1) and (2): . Facility Employee Name Training Date Hire Date' Trainer Names t 'SC�� G ,1 N' li41 E-1 1�9 ej .� q�,t f s Odle, vl �® - - -- 192016 / ✓ (Continued on reverse) e' i ` fterJuly I, 20K ' -a:i ust be a cmrrnt Detia micd UST Operator for dun fnelity a the time ofwaining. , - 112 wnw.unidors.org ENVIRONMENTAL HEALTH DEPARTMENT