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SAN JOAQUIN <br /> ---C O V N T v--._. <br /> Environmental Health Department <br /> Hazardous Materials Business Plan (HMB) Training Program <br /> Per Health and Safety Code 25505(a)(4, training for all employees and annual training, including <br /> refresher courses,shall include familiarity with the facility's Emergency response plans and <br /> procedures in the event of a release or threatened release of a hazardous material.Training <br /> shall cover, but not limited to, all of the following: <br /> (A) Immediate notification contacts to the appropriate local emergency response personnel and <br /> to the unified program agency. <br /> (B) Procedures for the mitigation of a release or threatened release to minimize any potential <br /> harm or damage to persons, property, or the environment. <br /> (C) Evacuation plans and procedures, including immediate notice, for the business site. <br /> These training programs may take into consideration of each employee. The use of this sign-in <br /> sheet is optional.The facility can choose to use any acceptable form to record the training(s). <br /> Employee(s)Training Sign In Form <br /> Course Name: M 2 Date: 5 1 2 0 2 v <br /> Facility Name: Instructor's Name: 7A0Et C <br /> OQ't W 12>L:C S'E e�4(_% c S T-< /` 1 *-0Wr4"tka/ <br /> Facility Address: �T, CERSID: t C) 72 23SC) <br /> Type(s)of Training: XClassroom Lecture ❑Tabletop Exercise ❑ Hands on <br /> ❑ Field Exercise Ksafety Meeting <br /> Summary of Training Topics Discussed: <br /> c�C:1:1 C YVie F u✓1 IG✓t <br /> O cc cl vY2 S O E E tJ r S i <br /> �U-�-� "Ccn�U✓1 a Pro rI'o,+c, ��'/E 'r.JC aM ,ti 7r <br /> rye o,+tuy7 5?"f ) AO(e W e /W Lr n fi7//i <br /> �VOL �UCt4- rJlof ✓1 <br /> �� <br /> REV. 11/18/2019 HMBP Program <br />