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i <br /> T . ININ Q RECORD <br /> Reportable Materials', CO2_Propane—Carwash Chemicals—Fuel_____ <br /> 3 <br /> Quik Stop MarketNumher:aQj Ip <br /> i � <br /> Employee Name(Print):9116" <br /> Purpose o1'Trriirtiaig: _Nese Employee/Initial Trtinim, <br /> New Assignments orChanges�in Routine/Equipmerit <br /> Annual Refresher Training <br /> Topics Covered- <br /> Hazardous Materials Management <br /> THazat>hu.s Materials Invenuiry/I Laudon (Pnil 1,HMMP. aka.Business Plan) <br /> Workplace Hcalth Hazards and Physical Hazards <br /> Location and Use of Material Safety Data Sheets(SL)S) <br /> Mcthmis ror Safe Flandhng orHayardous Material-, <br /> Emergerwy Response Procedures and Regulalory Requircments(outlined below) <br /> i <br /> Emergency Response <br /> l mcr�cncy Response Plan/Consolidated Contingency Plan {Pan I1, [Immi'} <br /> X ProceduresImCoordinalion with UwalFruergencyRe%pon%eOrganiralions <br /> __X Use of Emergency Response rquipment and Supplies <br /> XComnutnication quid Alarm Systems <br /> _ x Reslxntse to a Release or7breatuned Release ofFla7ardvus .rterials <br /> — 4 Response ur Fires. Explosiatr5, or F:itthquake Rel.med Gmun Molion <br /> 1-I04Erdorus Wi:stc Management(Not Applicable at Stores with only CO2 or Propane) <br /> )C -_14azarduus Watel7ctcrnvinatinn.AccumulatiotiTimc&QuaiitityLiniits <br /> Releas� Cmija envy Platt(Integi-oted with Consolidated Cuntingcncy Plan.above) <br /> Stuws' Area and Container Managemenl <br /> X Contiaikrs Properly Labeled, including BPA ID Number <br /> C CQJIdEIVtiny&RocwdingWeeklylnsVections <br /> T�_Manil4st Requirements 1'orOff--SiteTraEt,poit&Disposal <br /> Certification: <br /> I acknowledge that I have,reecived and completed training,in the-gubjec'Es above. so indicated by nay initials <br /> on the lines provid <br /> Train 1 Signature ate <br /> Trainingvcritiedby Z Z� <br /> Instructor Date <br /> i <br /> i <br />