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• - <br />:7 <br />TRAINING RECORD <br />Quik Stop Market Number; S 5 w 2S <br />Employee Name (Print): S AT $ 1 PZ G i L' L <br />Purpose of Training: New Employco/Initlal Training <br />New Assigrunents or Changes in Rcutine/Equipment <br />Annual Refresher Training <br />Topics Covered: <br />Hazardous Materials Management <br />Hazardous Materials Inventory/Location (Part I, ILViMP, aka, Business Plan) <br />Workplace Health Hazards and Physical Hazards <br />Location and Use of Material Safety Data Sheets (MSDS) <br />��k Methods for Safe (dandling of Hazardous Materials <br />Emergency Response Procedures and Regulatory Requirements (outlined below) <br />Emergency Response <br />Emorgoncy Response Plan/Consol!dated Contingency Plan (Part 11, HMMP) <br />Proceduros for Coordination with Local Emergency Response Organizations <br />Use of Emergency Response Equipment and Supplies <br />Communication and Alarm Systems <br />Response to a Release or Threatened Release of Hazardous Materials <br />Response to Fires, Explosions, or Earthquake Related Ground Motion <br />Haus Waste Management (Not Applicable at Stores with only CO2 or Propano) <br />Hazardous Waste Determination, Accumulation Time & Quantity Limits <br />Roloase Contingency Plan (Integrated with Consolidated Contingency Plan, above) <br />Storage Area and Container Management <br />Containers Properly labeled, including EPA ID Number <br />Conducting & Recording Wookly Inspections <br />Manifest Requirements for Off -Site Transport & Disposal <br />Certification: <br />I acknowledge that I have received and completed training in the subjects above, so Indicated by my initials <br />on the lin7"/./,/;, <br />ided. <br />21 :T'k .' 2 Li <br />Trainee Signature Date <br />Training verified by `� -- Zo21 ��'^� Z 1-i,, <br />ctor Data <br />