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JUN -13-22012 14:19 FROM: 0 T•8166eeet51 <br />I_I <br />UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING <br />For use by Unidocs Member Agencies or where approved by your Local Jurisdictlonl <br />Authority rited- Title 23, Div. 3, Ch. 16 Catifornia Code of ReKulalionr (CCR) <br />Facility Name: <br />.facility Site Address: <br />h City: <br />Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Sto. <br />provide training to facility employees who have responsibilities associated with the operation ani <br />underground storage tank (UST) systems. This training must be provided by July 1, 2005, and every 12 It <br />facility employees hired after July 1, 2005, the initial training must be provided within 30 days of the dati <br />or the fiacility employees present during oporating hours must have current training. This training mu; <br />limited to, the following items as specified in 23 CCR Sections 2715(0(1) and (2): <br />O Operation of the UST system in a manner consistent with the facility's Best Management Practi( <br />❑ The employee's role with regard to UST monitoring equipment as specified in the written UST i <br />❑ The employee's role with regard to spills and overfills as specified in the written UST Response <br />❑ Name(s) of contact person(s) for emergencies and monitoring equipment alarms; <br />E3 For facilities that are not routinely staffed. facility employee responsibilities as specified in the a <br />approved by the local 1 IST regulatory agency. <br />P.1/1 <br />Tank Operators <br />maintenance of <br />is thereafter. For <br />iire. At least one <br />:lude. but is not <br />toning Plan; <br />ng program <br />23 CCK § 2715(f)(3) requires that a list of employees who have been trained by the Designated Undergro' ~ Storage Tank <br />Operator(s) be maintained on-site, or off-site at a readily -available location if approved b the a local a enc `: d provided to <br />the local agency upon request. Completion of this form will satisfy Us"f training record keeping requircI i . The following; <br />employees have been trained as required by 23 CCR Sections 2715(f)(1) and (2): i <br />(Continued on reverse) <br />' If hired after July 1, 2005. <br />''Trainer must be a current Aosignated tls,r IcTantor roT die futility at the time orrruinin& <br />ITN -061 - 112 <br />www.uaiducs.urg <br />IN <br />07!13/015 <br />rITTIM"711111 <br />F114M, 1711 FIR, l <br />rim� <br />CAA <br />Ip <br />(Continued on reverse) <br />' If hired after July 1, 2005. <br />''Trainer must be a current Aosignated tls,r IcTantor roT die futility at the time orrruinin& <br />ITN -061 - 112 <br />www.uaiducs.urg <br />IN <br />07!13/015 <br />