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UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD <br /> For use bY Unidocs Alember Akencies or inhere approved bi,your Local Jurisdiction: <br /> Authoritt°Cited: Title 23, Div. 3, Ch. 16 California Code of Regulations(CCR) <br /> Facility Name: Pilot Flying J #1017 <br /> Facility Site Address: 345 Roth Rd. City: Lathrop, CA 95330 <br /> Section 2715 of Title 23, California Code of Regulations,requires that Designated Underground Storage Tank Operators pro- <br /> vide training to facility employees who have responsibilities associated with the operation and/or maintenance of underground <br /> storage tank (UST) systems. This training must be provided by July 1, 2005, and every 12 months thereafter. For facility <br /> employees hired after July 1,2005,the initial training must be provided within 30 days of the date of hire. At least one of the <br /> facility employees present during operating hours must have current training. This training must include,but is not limited to, <br /> 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 aggency,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 /> Facility Employee Name Training Date Hire Date Employee ID # Trainer Name <br /> >>" i $_ 26 - 17 F- Z4 -17 5y 7 38 Lmac e <br /> G� _ '-f-1( -C7 1 332 01 <br /> �? <br /> ', C S 17 2$ i� 13CoQ <br /> 3 --% 7/ n I`� <br /> Mklov - 2 T1s �r %z`�/� <br /> > 3`�1 `�/ <br /> sh)( t ,nC NeY�IC I% U a.5 t -1 �aq 1 G <br /> 2A-200 <br /> ec" a s' loe 3`-/ 17,10 <br /> UN-061-1/1 www.unidocs.ora, 07/13/05 <br />