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LEST Training,Ben Thomas,Instructor <br /> Ground FedEx Ground Class C Operator 3a9sDaisy lane,Clinton WA982BG <br /> ' <br /> 866-301-92555 4Vww.USTtraining-rom~` UST Facility Specific Worksheet <br /> Facility Name: UST Facility ID# 17- <br /> Facility Address: <br /> L6 5 57 <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 facilif}r <br /> • Class A or B training provider and Class C Operator must sign to verffy that all n ca <br /> Information to be reviewed by the Class A or 8 Operator; OL, 2 /201 r <br /> IdentReview the following information: nI I <br /> Location of Emergency Shut-off Switch Tank Monitor location,types of a1i 4V Q"UJAL HEALTH <br /> when there is an afarrn P ilEN <br /> Over-dill Alarm On-site Spill Response Procedures ENV-401 <br /> Dispenser Ernergeiricy Contact Information SPCC Poster <br /> Hose exouation of Posted Emergency Contact Information: <br /> . Nozzle Location of fuel dispensing permit this permit must be in <br /> place to authorize self-service <br /> Bmakam couplingcoupljng When it is appropriate to call"911" <br /> Fuel island drainage path In case of a Who to contact for non-eme enqy incidents <br /> significant spill(See SPCC Site Plan) <br /> That the delivery driver shall not remove a red tag at the <br /> ,e4, fill pipe of an underground tank <br /> Signage at the fuel island f=uel� Vsystem defects that should be reported to <br /> • management: <br /> Fuel Island Spill Supplies&contents Slow flow at the nozzle <br /> Location of fire extinguishers V Droken hose <br /> Communication systern Dame ed nozzle <br /> --'*A CLASS C OPERATOR MUST BE ON SITE AT ALL TITHES[TURING NORMAL OPERATING HOURS' <br /> Class A or B Operator Class C Operator <br /> By my signature below, I certify that 1 have provided By my signature below, 1 certify that 1 have recolved <br /> the ort-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 orB <br /> Operator. <br /> Print Name: Print Name: <br /> �--- Signature: Signature: <br /> Date: ./ " , 0!;Z_ Date- a <br /> MAINTAIN THIS DOCUMENT ON-SITE <br />