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0 <br />UNMI,RGROUND <br />STORAGE <br />. <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: Quik Stop Market #138 <br />Facility Site Address: 1153 Lincoln Boulevard <br />City: Tracy <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 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 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 location if approved by the local agency, 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 />FacilityEm to ee Name Trainin2 Date Hire Date' Trainer Name <br />(Continued on reverse) <br />If hired after July 1, 2005. <br />2 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 />