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UNSDIRGROUND STORAGE RMYSTEM <br /> DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD <br /> For use by Unidocs Member Agencies or where approved by your Local Jurisdiction <br /> Authority Cited: Title 23, Div. 3, Ch. 16 California Code of Regulations(CCR) <br /> Facility Name: 5-T0(_K-rb0 � 4,5-f* <br /> Facility Site Address: 2,coo city: S <br /> Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground 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 d q.te 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 /> ISl, The employee's role with regard to spills and overfills as specified in the written UST Response Plan; <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(s)be maintained on-site,or off-site at a readily-available Iodation if approved by the local ageau,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 /> 2 <br /> Facill E,l Trainer Name <br /> 0 mployee Name <br /> D <br /> AQj2,z ?moo 0 <br /> 07 <br /> (Continued on reverse) <br /> 1Ch4vd ager July 2005. <br /> Trainer must be a current Designated UST Operator for the facility at the time of training. <br /> UN-061 -1/2 www.unidocs.org 07/13/05 <br />