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UST Training,Ben Thomas,Instructor <br /> Ground FedEx Ground Class C Operator 3495 Dalsy fame,Clinton WA 98,286 <br /> 866-301-8265 www.USTtraining.corn <br /> UST Facility Specific Worksheet <br /> Facility Name: UST Facility ID# <br /> Faciiity Addre5S: <br /> Worksheet Instructions: <br /> * The Class C Operator must complete the required onsite training following completion of the Class C online <br /> training course (EAW-905). <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. <br /> • Class A or B training provider and Class C Operator must sign to verify that+'ill zmtr#ng has been c6mok"i., <br /> Information to be reviewed by the Class A or E Operator: 2/; <br /> ldent' : Review the following information: /�q <br /> Location of Emergency Shutoff Switch Tank Monitor location,types of �gl,g a <br /> when there is an alarm ®EP�,"ENT <br /> ver-fill Alarm On-site Spill Response ProcedLiFes ENV-401 <br /> is enser EmqrgenSy Contact Information SPCC Poster <br /> Hose Location of Posted Emergency Contact lrrformation: <br /> �-, Nozzle ocation of fuel dispensing permit this permit must be in <br /> place to authorize self-service <br /> Breakaway Coupling When it is appropriate to cail'911" <br /> Fuel Island drainage path in case of a Who to contact for nqn-eme[gancy 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 /> / marry ement: <br /> uel Island S i[I Supplies&contents y Slow flow at the nozzle <br /> ocation of fare exon uishers Broken hose <br /> Commuriication system Dama ad nozzle <br /> � A CLASS C OPERATOR MUST BE ON SITE AT ALL TIMES DURING NORMAL OPERATING HOURS" <br /> Class A or B Operator Class C Operator <br /> By my signature below, I certify that I have provided Sy my signature below, f certify that I have received <br /> the on-site training covered by fhls worksheet with the 1 and completed the required Class C training and this <br /> warned Class C Operator- d worksheet review with the facility's Class A or B <br /> Operator_ <br /> Print Name-. per:: rtr Print Name: <br /> Signature: Signature: - <br /> Date: Z2 57, Date_ 1CD zT <br /> MAINTAIN THIS DOCUMENT ON-SITE <br />