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MAINTAIN THIS FORM THE ENTIRE TIME THE EMPLOYEE WORKS AT THE FACILITY <br />ON-SITE TRAINING FORM <br />ANNUAL REFRESHER TRAINING VERIFICATION <br />Y <br />Name of Company:i ((;� " <br />Street Address: " 1 J > 3 <br />City, Zip Code: 1 C <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 />Z <br />Initial <br />Date <br />Hazardous Materials Management (Hazardous Materials Management/Business Plan <br />1. Which materials at the facility are hazardous <br />L <br />2. Where these materials are stored <br />S <br />3. How these materials are to be handled, stored, and disposed of <br />4. What Material Safety Data Sheets (MSDS) are and where the are kept at the facility�. <br />Z <br />5. Training topics included in the HMMP, including review of MSDS and the emergency <br />response an <br />�� . <br />.Z ') <br />Spill and Leak Response (Spill Response Plan <br />1. Location of spill response equipment <br />7 2? <br />2. Location of spill or leak contact list, reporting procedures <br />- ,od <br />3. Location of emergency fuel shut-off switch <br />Employee Signature <br />Training verified by <br />Social Sec. Number Date <br />Instructor <br />Date <br />MAINTAIN THIS FORM THE ENTIRE TIME THE EMPLOYEE WORKS AT THE FACILITY <br />Z <br />2 <br />