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03/15/2012 12:32 209367q&Qd BAGLEY ENTERPR ''rS PAGE 02/92 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED OpE.RATOR FACILITY EMPLOYEE G RECORD <br /> For use by Un does Meng Agepxws or Www app vved byyow Zoart.uns elFam <br /> Au&oriry Cited_ Tate 23,Div_3,Ch_l6CQlffwr j4 Code of pM <br /> Facility Name: �'- 3 s;,�ca 'Y <br /> FaCility Site Address: CkW (^=Wo �,�, a - <br /> city= <br /> Section 2715 of ThIc 23,California Coetc of'p"9 ti"recgsires iters UOderground 3tmp Tame Operators <br /> provide and t�mg g facility.e r r(U empltryees <br /> '°' storage who have re Pumbilitm a ciated wdb the operation and/or maintenance of <br /> systoms. TNS tram ram be prbvnded by July 1,2005.and every 12 zncmths th�esfter. <br /> For faeility employees hired alter fitly 11 2005,the initial lra g r�be PmvWW wift 30 days of the slate of hire.At <br /> icast one of the facility employees present dorm Mcrating his motet have cmi+ent trairrirfg.Thfth is <br /> is not Bruited to,the following items as must include,bta <br /> sQaci�ed 23 CCR Sections z71s(f)(1)and(2): <br /> ❑ Operation of the UST system in a maturer coned W with the facility's Hest Unweement Practices- <br /> 13 1 he employee's role with regard to UST monitoring as is the witben USS'Monitoring Plan; <br /> EJ The employee's MIC with regard to spills and as m the written U 5T �y it <br /> ® Name(-%)of contact petson(s)for emergencies and monitoring 0TApMeW mss; <br /> El For facilities that are not routinely.ftfkd,facility WVloyce muton- ilities as <br /> VOCIfied approved by the local Usk'regulatory ,. in the tretning program <br /> 23 CCR§2715"3)r*quires that a Wit,ofemploy=wbo have been trained•by the Dedgl3st0d UV4 <br /> �mtor(s) on-site,or elf-site at a readdy-evadable tocati�on iF by the local d storage Wank <br /> the local agency upon mgtL Completion of Oris form will � and provided to <br /> em 10 ccs have been as 'UST hams*acord keeoW mpiwments.The following <br /> P Y mgteed by 23 CCR Sect�ions�,271VXI)and(2): <br /> FmtC - laM§yft NSXM Bart D T - N <br /> 3 <br /> w <br /> (Cosdaaed on mvelso <br /> 'zfhimd ftar July 1,2005. <br /> =trsia�mwt be s CWt=t D&4 USr a"ti a A= rhe d8W of <br /> UN-061-W <br /> erw�ro�idoaorg 07ft3/t15 <br />