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UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED OPERATOR FACIELM EWLOYEF TRAENING RECORD <br /> For use by Unidacs Member Agencfes or where approved by your Local Jurisdiction <br /> Authority Cited: 77tle 23,Div. 3, Ch 16 California Code of Regulations(CCR) <br /> Facility Name: Z <br /> Facility Site Address: _ �� � �1/4-a City: ; Grp <br /> Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators <br /> provide'train� to facility employees who have responsibilities associated with the operation and/or maintenance of <br /> underground storage tank(UST) systems_This trwn m g must be provided by July 1,2005,and every 12 months thereafter. <br /> For facility employees hired after Iuly 1, 2005,the initial training must be provided vdtbin 30 days of the date of hire. At <br /> least one of the facility employees present during operating hours must have current training.This training must include,but <br /> isnot limited to,the following items as speeified in 23 CCR Sections 2715(f)(l)and(2), <br /> Cl Operation of the UST system in a maimar consistent with the facility's Rest Management Practices-- <br /> El <br /> ractices;E l The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; <br /> ❑ The employee's role with regard to spills and overfills as specified in the written LIST Response Plate <br /> ❑ Name(s)of contact person(s)for emergencies and monitoring equipment alarms; <br /> ❑ For facilities that are trot routinely staffed,facility employee responsibilities as specified in the training program <br /> approved by the local UST regulsiory agency. <br /> 23 CCR§2715(#)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank <br /> Operators)be maintained on-sire,or off-site at a readily-available location if atst)roved by the local agency$rid provided to <br /> the local agency upon request*Completion of this form will satisfy UST training record keeping requirements-The following <br /> employees have been trained as required by 23 CCR Sections 2715(f)(1)and(2): <br /> Facility Em to ee Name Trab3ing Date Elia Dates Trainer NameZ <br /> N <br /> b d ? L <br /> :. . <br /> .. , <br /> s-" <br /> (Continued on reverse) <br /> i <br /> if birm aft=July 1,2005. <br /> a Tr4iaer mist be a cmee Das%nated UST CVu% [for tlw f wOity at the time of tCainifl$ R E <br /> /13N5 <br /> UN-06t-213 w+WW.unid4egu rg <br /> h—T 24- 2017 <br /> 01 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />