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UST Trainirng,ben Thomas,Instructor <br /> Feb <br /> G-round FedEx Ground Class C Operator M.5S Daisy Iarie,Crimon WA 99235 <br /> 86Cr3C71-8265 www,tJSTtraining.com <br /> UST Facility Specific Worksheet <br /> Facility Name: $ l 1? 6, UST Facility ID# <br /> Facility Address: <br /> Worksheet instructions: <br /> The Class C Operator must complete the required on-site training following completion of the Class C online <br /> training course (ENV-105). <br /> Class C Operator must complete all training prior to assuming responsibility for response to emergencies <br /> related to a spill or release of a regulated substance at the facility. b ; <br /> • Class A, or B training provider and Class C Operator must sign to verify tha 17 <br /> 6 <br /> ,4 <br /> Information to be reviewed by the Class A or 8 Operator: <br /> Ident' : Review the following information: <br /> n�`I�q LTH <br /> Location of Emergency Shut-off Switch Tank Monitor location,types ef'01Aith; t <br /> when there is an alarm ® T <br /> Over-frill Alarm On-site Spill Response Procedures ENV-401 <br /> Dls enserEm ercencv Contact Information SPCC Foster <br /> 41 Hose Locatson of Posted Eme-gency Contact Wormatium <br /> Nozzle Location of fuel dispensing permit this permit must be in <br /> place to authorize self-service <br /> Breakaway Coupling When it is appropriate to call-911" <br /> Fuel island drainage path in case of a Who to contact for non-emerge cincidents <br /> significant spill(see SPCC Site Plan) <br /> That the delivery driver shall not remove 2 red tag at the <br /> l fill pi of an underground tank <br /> Signage at the fuel isfand }( Fuel system defects that should be reported to <br /> �1 mane enient: <br /> Fuel Island Spill Supplies&contents NJ I Slow flow at the nozzle <br /> Location of fire extinguishers Broken hose <br /> Communications stem Damaged nozzle <br /> ""*"°A CLASS C OPERATOR MUST BE ON SITE AT ALL TIMES DURING NORMAL OPERATTNG FLOURS'*"'*' <br /> Class A or B Operator Class C Operator <br /> By my signature below, 1 certify that i have provided By my signature below, 1 certify that I have received <br /> the on-site training covered by this worksheet with the and completed the required Class C training and this <br /> named Class C Operator_ �► worksheet review with the facility's Class A or <br /> operator- <br /> Print <br /> 7 eratorPrint Name.: Print Name: J-10 } tel t-t 410,-T 1 r.1 f 2— <br /> Signature: Signature: <br /> Date: / C> Date- / <br /> MAINTAIN THIS DOCUMENT ON-SITE <br />