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ON-SITE TRAINING FORM - <br />Name of Company: <br />Street Address: <br />City, Zip Code: <br />Employee Name (Print <br />NEW F4MPLOYEE TRAINING VERIFICATION <br />/ &A.� s <br />I acknowledge that I have received and understand environmental compliance training in <br />the following areas (please initial or mark N/A for not applicable): <br />Employee Signature <br />Training verified by <br />Social Sec. Number Date <br />Instructor <br />JAN 0 4 2023 <br />ENVIRONMENTAL HEALTH <br />PERMITISERVICES <br />Date <br />t <br />r - <br />Initial <br />Date <br />UST System Operations <br />1. <br />The types and locations of the tanks at the facility <br />XkJu <br />12 / <br />2. <br />The type and operation of the leak detection system <br />4AA4J <br />3. <br />For electronic monitors, daily monitoring check log and alarm log <br />Hazardous <br />Materials Management (Hazardous Materials Management/Business <br />Plan) <br />1. <br />Which materials at the facility are hazardous <br />2. <br />Where these materials are stored <br />koxZ <br />/ <br />3. <br />How these materials are to be handled, stored, and disposed of <br />4. <br />What Material Safety Data Sheets (MSDS) are and where they are kept <br />at the facility <br />5. Training topics included in the HMMP, including review of MSDS and <br />response plan <br />the emergency <br />J <br />ivw�z <br />Spill <br />and Leak Response (Spill Response Plan) <br />1. <br />Location of spill response equipment <br />2. <br />Location of spill or leak contact list, reporting procedures,�J <br />3. <br />Location of emergency fuel shut-off switch <br />Inventory Reconciliation <br />1. <br />How to perform accurate inventory control <br />14WAJLl <br />2. <br />Follow-up of gasoline inventory overage/shortage (variance) <br />O',A A� <br />3. <br />Reporting and maintaining inventory records <br />Daily <br />Self Inspection* <br />1. <br />Type and operation of vapor recovery equipment at the facility <br />2. <br />How to perform daily inspection of equipment <br />�yvtJ <br />l ? <br />3. <br />Procedures for non-compliance equipment (tag out of order), complete <br />maintenance log <br />I eKvu✓ <br />Record Keeping (Maintenance, monitor, testing, wastes, inspections, inventory, permits, <br />training, <br />tc.) <br />1. <br />Location where records are kept <br />2. <br />Types of records maintained at the facility/ length of time each record <br />should be kept <br />Employee Signature <br />Training verified by <br />Social Sec. Number Date <br />Instructor <br />JAN 0 4 2023 <br />ENVIRONMENTAL HEALTH <br />PERMITISERVICES <br />Date <br />t <br />r - <br />