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ON-SITE TRAINING FORM - NEW EMPLOYEE TRAINING VERIFICATION <br />Name of Comp <br />Street Address, <br />City, Zip <br />Employee Name (Print) <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 />Training verified by <br />ll <br />Social Sec. Number <br />Instructor <br />JAN 04 2023 <br />ENVIRONMENTAL HEALTH <br />PERMITISERVICES <br />/1 '1 <br />Date <br />Date <br />Initial <br />Date <br />UST System Operations <br />1. <br />The types and locations of the tanks at the facility <br />2. <br />The type and operation of the leak detections stem <br />3. <br />For electronic monitors, daily monitoring check log and alarm log <br />2 21 72W2 <br />Hazardous Materials Management(Hazardous Materials Man agement/Bu siness <br />Plan <br />1. <br />Which materials at the facility are hazardous <br />r? <br />2. <br />Where these materials are stored <br />C" <br />3. <br />How these materials are to be handled, stored, and disposed of <br />L <br />4. <br />What Material Safety Data Sheets (MSDS) are and where they are kept at the facility <br />, <br />Z <br />5. Training topics included in the HMMP, including review of MSDS and the emergency <br />response plan <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 <br />24 02 <br />3. <br />Location of emergency fuel shut-off switch <br />217 <br />Inventory Reconciliation <br />�- <br />1. <br />How to perform accurate inventory control <br />, <br />a 7 <br />2. <br />Follow-upof gasoline inventoryoverage/shortage variance <br />- <br />3. <br />Reporting and maintaining inventory records <br />., <br />Paily Self Inspection* <br />1. <br />Type and operation of vapor recovery equipment at the facility <br />2. <br />How to perform daily inspection <br />of equipment <br />3. <br />Procedures for non-compliance a ui ment(tag out of order), complete maintenance log <br />lei <br />00 <br />Record Keeping (Maintenance, monitor, testing, wastes, inspections, inventory, permits, <br />training, etc. <br />1. <br />Location where records are kept <br />2. <br />Types of records maintained at the facility/ length of time each record should be kept <br />Training verified by <br />ll <br />Social Sec. Number <br />Instructor <br />JAN 04 2023 <br />ENVIRONMENTAL HEALTH <br />PERMITISERVICES <br />/1 '1 <br />Date <br />Date <br />