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UNDERGROUND STORAGE TANK *TEM <br />DESIGNATED OPERATOR FACILITY ENJ[PLOYEE TRAINING RECOR-1 <br />For use by Unidocs Member Agencies or where approved by your Local Jurisdiction <br />Authority Cite& Title 23, Div. 3, Ch 16 catifornia code of Regulations (CCR) <br />AX -CV k10 V1 I <br />Facility Site Address: <br />La <br />Section 2715 of Title 23, California Code Of Regulations, requires that Designated Underground Storage Tank Operators <br />sponsibilities associated with the operation and/or maintenance of <br />provide training to facility employees who have re thereafter. For <br />underground storage tank (UST) systems. 'Ibis training must be provided by July 1, 2005, and every 12 months <br />MM71m7fflym-Y �,Wj-z=ma 'Wint <br />it 0 mMal tramWj� must be provided within 30 days of the date of hire. At least one <br />-th <br />of the facility employees present during operating hours must have current training. Ibis Uiglff <br />limited to, the following items as specified in 23 CCR Sections 2715(f)(1) and (2): <br />14 Operation of the UST system in a manner consistent with the facility's Best Management Practices, <br />8 The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; <br />Ef The employee's role with regard to spills and overfills as specified in the written UST Response Plan; <br />13 Name(s) of contact person(s) for emergencies and monitoring equipment alarms; <br />0 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(t)(3) requires that a list of employees who have been trained by the Designated Underground Storage Tank <br />operator(s) be maintained on-site, or off-site at a readily -available location if V -0 <br />pLoved. by the local men and provided to <br />rv�411vz7n%� CoM�Lletion of this form will satisfy UST training record keeping requirements. The following <br />have been trained as required by 23 CCR Sections 2715(1 T <br />Facility, Emp to NameTTrai��Bing <br />Date <br />EUre Da <br />T er Name2 <br />Y1 <br />01 <br />iv� j <br />C4 <br />' If hired after July 1. 2005- the facility at the time of training. <br />ITN -061 - 112 wwwxnidomorg 07/13105 <br />