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a UNDERGROUND STORAGE TANK SYS DESIGNATED OPERATOR FACILffy EMPLOYEE For rise by Unidocs Member Agencies or where appro.,ed Authorit;,.CitedTide 23, Div_ al%Juridicti 3, Ch J6 Califomia Cod f egulations(CCR) onJ cal isdica Facility Name: Facility Site Address: _ ,��1 `- ��., City: Section 2715 of Title 23, California Code of Regulations, requires that Designated Under ora provide training to facility employees who have o Underground Stge Tank operators underground Storage tank ST responsibilities associated with the operation and/or maintenance of (UST)systems.This training must be provided by July 1,2005,and every 12 months thereafter-For facility employees hired after-July 1,2005,the initial training must be provided within 30 days of the date of hire-At I of the facility employees present during operating hours must have y limited to,the following items as current training. This east one specified in 23 CCR Sections 2715 g training must include, but is not D Operation of the UST system in a manner consistent with theflf-(acility,s Best Management practices; The employee's role with regard to UST monitoring equipment as specified in the written U ST Monitoring plan, The employee's role with regard to spills and overfills as specified in the written UST Response Plan; 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§2715(0(3)requires that a list of employees who have been trained by the Designated Under grotmd Sto e Tank OPemtor(s)be maintained on-site,or off-site at a readily-available to the local agency upon request.Completion of this form will satisfy UST training in rif %rovrd kd by eeping requirements. The following employees have been trained as required by 23 CCR Sections 2715(f)(1) p g (�( )and(2): ng ac' ' Em to ee N Training Date Hire Date' Traine I ez 3o q �� - ,I -- (Continued on reverse) 'If hired after July 1,2005. Trainer must be a current Designared LIST operatar for the facility at the tont of training- UN-061 raining. [11�I-061-V2www.00idomorg 07/13/05