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ON-SITE TRAINING FORM = <br />Name of Company: <br />Street Address: <br />City, Zip Code: <br />Employee Name <br />NEW EMPLOYEE TRAINING VERIFICATION <br />), / zpk acs 42, <br />I acknowledge that I have received and understand environmental compliance training in <br />the following areas (Dlease initial or mark N/A for not applicable): <br />d�7 <br />Jo7 <br />Initial <br />Date <br />UST System Operations <br />1. <br />The types and locations of the tanks at the facility <br />—2 =2, <br />2. <br />The type and operation of the leak detections stem <br />Z�LI —2 <br />3. <br />For electronic monitors, daily monitoring check log and alarm log <br />49 <br />Hazardous Materials Management(Hazardous Materials Management/Business <br />Plan) <br />1. <br />Which materials at the facility are hazardous <br />�l — <br />2. <br />Where these materials are stored <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 />2 �� <br />5. Training topics included in the HMMP, including review of MSDS and <br />response plan <br />the emergency <br />Spill <br />and Leak Response (Spill Response Plan <br />1. <br />Location of spill response equipment <br />(L^A rZ <br />2. <br />Location of spill or leak contact list, reporting rocedures <br />4l2' <br />1 <br />3. <br />Location of emergency fuel shut-off switch <br />9 2J <br />Inventory Reconciliation <br />1. <br />How to perform accurate inventory control <br />1 �O;LI " <br />2. <br />Follow-up of gasoline inventory overage/shortage (variance) <br />7— 7.1 <br />3. <br />Reporting and maintaining inventory records <br />4sl — <br />Daily Self Inspection* <br />Swe— SLI <br />1. <br />Type and operation of vapor recovery a uipment at the facility <br />2. <br />3. <br />How to perform daily inspection of equipment <br />Procedures for non-compliance equipment (ta out of order), complete <br />maintenance log <br />j7 -- <br />Record Keeping (Maintenance, monitor, testing, wastes, inspections, inventory, permits, <br />training, etc. <br />1. <br />Location where records are kept <br />'LCL. — 2 <br />2. <br />Types of c rds maintain at the facility/ length of time each record <br />should be ke t <br />12 ZI <br />Employee Signature <br />i by <br />Social Sec. Number <br />Instructor <br />JAN 0 4 203 <br />ENVIRONMENTAL HEALTH <br />PERMITISERVICES <br />