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Certification of Training Completion for <br /> UST Facility On - Site Operator <br /> My name is /T, k�'e //0 ;k-3 and I am an <br /> employee of <br /> I understand that in order to ensure a safe and reliable operation of the petroleum <br /> fueling systems, proper inspection , maintenance , and repair of the equipment will be <br /> necessary. <br /> Due to fire and environmental hazards involved in the handling of flammable and <br /> combustible liquids , all maintenance and repair work on fueling systems must be <br /> performed by properly trained personnel . <br /> I certify that I have been trained to : <br /> • Perform a Daily Inspection of the dispensers , hoses , and nozzles , <br /> v Inspect tank fill and vapor recovery spill buckets . Have cleaned as needed and <br /> dispose as hazardous waste and document. <br /> Response to monitoring system warnings or alarms and have documentation . <br /> • Clean exterior of the dispensers . <br /> • Knowledge of the location of the emergency stop switch . <br /> • React to emergency situations including activation of the emergency stop <br /> switch . <br /> • Properly use fire extinguishers . <br /> • Properly response to spills . <br /> I understand and acknowledge that I am not authorized to perform services for which I <br /> have not been trained. <br /> Signature <br /> Print Name <br /> �/f Z�) <br /> Date <br />