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UST Training,Ben Thomas lnskruaar <br /> 3495 Daisy lane,DInton WA 98236 <br /> Ground 3435 <br /> WWw.U5Ttr3ining.cv <br /> FedEx Ground Class C Operator m <br /> UST Facility Specific Worksheet <br /> Facility Name: UST Facility 1D# <br /> Facility Address: <br /> Worksheet Instructions= <br /> • The Class C Opemformust complete the required on-site training following completion of the Class C online <br /> training course(ENV-1 ob). <br /> • Class C operator must complete all training prior to assuming responsibility for namonse to emergencies " <br /> related to a spill or release of a regulated substance at the facility- . `3 <br /> • Class A or B framing provider and Class C Operator must sign to verify that altInIg6as `een completed <br /> X35 T 7"L- C 4 OCT 2� Z017 <br /> Information to be reviewed by the Class A or B Operator: W <br /> Identi : 'Review the follovying information_ _EL&jBQNMENTAL HEALTH <br /> �a <br /> f�ter- <br /> f Location of Emergency Shut-off Swptch Tank Monitor location,types of alarms and [dA' vMnf tt,ere <br /> is an alarm <br /> Over-fill Alarm On-site Spill Response Procedures ENV-401 <br /> Dispenser Emergency Contact Information SPCC Poster <br /> Hone Location of Posted EmernencV Contact Information <br /> Nozzle Location of fuel dispensing permit this permit must be in place to <br /> 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-emergency incidents <br /> significant spill(see Plan)SPCC/Emergency That the deliverydriver sha)l not remove a red to at the fill pipe of <br /> Response ERP Site Plan) an under round tank 9 p p <br /> Signage at the Fuel Island Fuels stem defects that should be reported to mann ement; <br /> Fuel Island Spill Supplies&Contents Slow flow at the nozzle <br /> Location of Fire Extin uisherS Broken hose <br /> Communication stem Rama ed nozzle <br /> "'*"A CLASS C OPERATOR MUST BE ON SITE AT ALL TIMES DURING NORMAL OPERATING HOURS""* <br /> Class A or B Operator Glass C Operator <br /> BY my signature below, 1 certify that 1 have provided By my signature below, 1 certify that l have mceived <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 B <br /> Operator <br /> Print Name: iaUt ,. Print Name: <br /> 4 <br /> Signature: Signature:. <br /> Date: le--' all Date: _ <br /> MAINTAIN THIS DOCUMENT ON-SITE <br /> Rev.9/1 S=16 <br />