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UNDERGROUND STORAGE LANK SYSTEM G RECORD <br /> DESIGNATED OPERATOR FACILITY EMP T RAPdN <br /> Jurisdiction <br /> For use by Unidocs Member Agencies or where approved by your <br /> Authority Cited- Title 23,Div 3, Ch. 16 California Code of Regulations(CCR) <br /> Facility Name: ---- <br /> 1 <br /> Cit),: <br /> Facility Site Address: k-11 � E � �� v <br /> Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground <br /> 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.For <br /> facility employees hired after July 1,2005,the initial training must be provided within 30 days of the date of hire.At least one <br /> of the facility employees present during operating hours must have current training. This training must include, but is not <br /> 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 Pian; <br /> ❑ Name(s)of contact person(s)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(f)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank <br /> Operator($)be maintained on-site,or off-site at a readily-available location if approved by the local astencv,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(f)(1)and(2): <br /> Facility Employee Name Trafia!pg Date Rare Dater Trainer Name — <br /> 5 � <br /> t.0 Z Ub to. L.�, <br /> r L4% 116zl <br /> MAR 2 8 2017 <br /> DEPARTMENT <br /> (Conduced on reverse) <br /> If hired after July I,2005. <br /> z Trainer must be a current DesigWed UST opmmm for the%,,iuty at the t-,me of training. <br /> ITN-061-1/2 www.unidoes.org 07113/05 <br /> P� sd� <br />