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UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD <br /> F'or use by Unidocs Member Agencies or where approved bj,yonr Local Jurisdiclion <br /> Authorit),Cited Title 23,Div. 3, Ch. 16 California Code of Regrdations(CCR) <br /> Facility Name: _ <br /> Facility Site Address: fa5�� A,4/ City: , Qej <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_ <br /> For facility employees hired after July 1,2005, the initial training must be provided within 30 days of the date of hire. At <br /> least one of the facility employees present during operating hours must have current training.This training must include,but <br /> is not limited to,the following items as specified in 23 CCR Sections 2715(0(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'fank <br /> Operator(s)be maintained on-site,or off-site at a readily-available location if approved by the local aaencv,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 /> Facili Fm to ec Name Training Date Hire Date' Trainer Name' <br /> b I p( <br /> _� - - <br /> 10 S' ^ 2 b 5 o i <br /> D0s, G <br /> ItiZr, <br /> (Continued on reverse) RECEIVED if hired ager lily 1,2005. <br /> Trainer must be a current Designated UST Operator for the facility at the time of training. <br /> IW-0(1-1/2 rvnv .unidocs.org AUG 2 3 2018 07/13/05 <br /> ENVIRONMENTAL HEALTH <br /> CD,: APTrU1ERj-r <br />