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t ' i s , i f t UNDERGROUND STORAGE TANK SYSTEM I DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD 1 For use by Untdots Member Agencies or where approved by your Local Jurisdiction Authority Cited. 71tle 23, ,Div.3,Ch.16 Caltyornia Code of Regulations(CCR) i Facility Name: Facility Site Address: 7j Q�,�(', City: I � _ Section 2715 of Title 23, California Code of Regulations,requires that Designated Underground Storage Tank Operators provide training to tlteility employees who have responsibilities associated with the operation and/or maintenance of underground storage tank(UST) systems.This training must be provided by July 1,2005, and every 12 months thereafter. i For facility employees hired atter July 1,2005, the initial training must be provided within 30 days of the date of hire.At least one of the facility employees present during operating hours must have outrent training.This training must include,but is riot limited ID,the following Items as specified in 23 CCR Sections 2715(1)(1)and(2): Operation of the UST system in a manner consistent with the facility's Best Martagement Praotices; The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Flan; The employee's role with regard to spills and overfills as specified in the written UST Response Plan; Name(s)of contact person(s)far emergencies and monitoring equipment alarms; ❑ For facilities that are not routinely staffed,facility employee responsibilities as specified in the training program approved by the local UST regulatory agency. 23 CCR§2715(t)(3)requires that a list of employees who have been trained by the DesIpated Underground Storage Tank Operators)be maintained on-site,or off-site at a readily-available location if oMyod h the lopd age—nm and provided to the local agency upon request.Completion of this form will satisfy UST training record keeping requirements.The following employees have been trained as required by 23 CCR Sections 2715(f)(1)and(2): ! Faeili Em o ee Name Trainitx Date ffire Dater TrOlner Nam sem, �- �► f I } i t , 1 I I i I (Continued on reverse) t if hired agar July 1,2406. 'Trainer must be a current Dwignated UST Operator ran the facility at the time of training. t VN-"i-212 www.oaidoes.org 09/23103 1