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UST Training,Ben Thomas,Instructor <br /> FecEx. � <br /> Ground FedEx Ground Class C Operator 34950aisylane,Clinton WAg8236 <br /> 866r3n1-8265 www.USTtraining-corn <br /> UST Facility Specific Worksheet <br /> [Facility Name; `-� UST Facility ID# OC(IS <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 tmining prior to assuming responsibility for response to emergencles <br /> related to a spill or release of a regulated substance of the facility. <br /> Class A or B treirring provider and Class C Operator must sign to verify t#ra tfiaining has been corimple .` <br /> Information to be reviewed by the Class A or B Operator. OCT 2/1 20 <br /> Idem` _ Review the followinq information:_ . `,_. TH <br /> Location of Emergency ShutofF Switch Tank Monitor location,types of alarrrr old*I1a�red r <br /> when there is an alarm' <br /> Over-fill.Alarm l; On-she Spill Response Procedures ENV-491 <br /> U/ Dis enser Emergency Contact Information SPCC Poster <br /> Hose Location of Posted EmerQency Contact Information: <br /> Nozzle Locatart of fuel dispensing permit this permit must be in <br /> lace to authorize self-service <br /> Greakavy-gy Coupling V/ When It is appropriate to call"911" <br /> Fuel Island drainage path in case of a Who to contact for nan*emergency incidents <br /> significant spill(see SPCC Site Plan) <br /> That the delivery driver shall not remove a red tag at the <br /> fill pipe of an underground tank <br /> Signage at the fuel island Fuel system defects that should be reported to <br /> mane ement: <br /> Fuel Island Spill'Supplies&contents Slow flow at the nozzle <br /> ovation of fire extinguishers Broken hose <br /> CCommunlcation systern V -Damaged 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, I certify that I have providod 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 B <br /> / <br /> Operator. (+ <br /> Print Name_ , C /I'fir- ,f/ Print Name: <br /> -�-, Signature: Signature: y <br /> Date; /f - ,5--- 2017 Date: I <br /> MAINTAIN THIS DOCUMENT ON-SITE <br />