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FACIL UNDERGROUND SrDRAGE TAINIK <br /> trY EMPLOYEE TRAINING CERTIFiIATE c>a <br /> BuiI' FACILITY INFOR <br /> rm� NfSamr� as ��CFfr>`y Nature of p$A-gyp n I11WTio}V <br /> �dp'SrnpsS T1s; - <br /> y CERS 1 <br /> Susiness Sete Address <br /> I Z1p c"In <br /> l>. DESfGNfL' f7 UINIDERGROUND STORAGE <br /> Nme TANK OPERATOR iNFORFAAT7QN l <br /> aof Deslgnasad ti$T p@F$figF PJ vrding 1.61q -b n nq rP r,as sh4wfl an rhe awC Cerrrrarl <br /> Maiknp Address ' <br /> PQ Sox 933, West S acramento C a 5605 I PhDn$� <br /> Fcc CwIrficaba-x III (9l 371- 38C <br /> i IrC CeruEc+rjkvn Exarsba,Date <br /> _ . C7 <br /> III_ <br /> FACILITY EMPLOYEE 1NFORMATIOIri <br /> IInd fvlduars assuming the dutjn Of III faCilrty employee before October 13. 2018 must be trajne(I WIN In 3t}days of pefform <br /> facility arnployee dirties. Individuals assuming the duties of tyle facility employee On arld After Octobor 13,2018 snuat btu trafr <br /> before performing faciiity em P1 Oyes duties. <br /> Check this box if a fist of the indM#uafrs) trainect is appended Cc this form. The appended hu; at a r ;nlrnum, must coat. <br /> aJ1 at'the information In this section- <br /> Date 4f UsrumiN I <br /> Name of lndfvodual(s) Trained Initial Training Date Responsiblllty as <br /> r-aciliiy Ernptcy" <br /> r <br /> Ia .' • � .- <br /> r I <br /> I + <br /> Ill, CERTIFICATION 6Y DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The faC;jIIty 0rnp)ayees listed above have cornpleted the raqulmd training in accordance with California Gods of Reg Lila tio+ <br /> Title 23. DiviSl0n 3. Chapter 16. Section 2715IcI and till the information provided herein is accurate. <br /> 5 nanufe Date of T: anln� <br /> Training Des�riawO UST OpefBtoF 9 ; <br /> CS=C.alfvrnrd ErTvIrm <br /> rrwrl d FWPI •ib;-IoErlf9hc2 Wa =Irwnatw..W COIJe C AXk LIST=Urro. Ird StwQa Tzrt <br />