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UST Training,gen Thomas,Instructor <br /> 3495 Daisy lane,Clinton WA 98236 <br /> 8E6-341-8255 www.USrtraining_com <br /> FedEx Ground Class C Operator <br /> UST Facility Specific Worksheet <br /> Facility Name: F UST Facility ID# <br /> Facility Address: <br /> Worksheet Instructions: <br /> * The Glass C Operator must complete the required on-site training following completion of the Class C online <br /> training course (ENV 905). <br /> a 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 mustsign to verify that al]'tr rig has been cvmpiefec� <br /> Information to be reviewed by the Class A or B Operator. OUT 2x ZQl7 <br /> Id tify, Review the fol lowirig information: <br /> Location of Emergency Shut-off witch Tank Monitor location,types of affihh q i7il'QAIVr PA EUI/tette r I l <br /> an alarm _DA r. 'ENT <br /> Over-fill Alarm 7 on-site Spill Response Procedures ENV-401 <br /> Dispenser Emergency Contact Inibrmation SPCC Poster <br /> r,1 <br /> Hose Lecstion of Posted Emergercy EmergencyContact Information <br /> Nozzle Location of fuel dispensing permit this permit must be in place to <br /> uthorize self-service <br /> Breaknway Coupling When it is appropriate to Call"919" <br /> Fuel Island Drainage Path in case of a Who to contact for non-ernergenR Incidents <br /> significant spill(see SPCC/Emergency <br /> Response ERP Site Plan) That the delivery driver shall not remove a red tag at the fill pipe of <br /> n underground tank <br /> ul V1 <br /> Si na e at the Fuel Island Fuel system defects that should be reported to management <br /> Y Fuel Island 5 ill SUIPPlies$Contents Slow flow at the nozzle <br /> Location of Fire Exon uishers Broken hose <br /> Communication System Damaged 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, 1 certify that f have,provided By my signature below, 1 certify that 1 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 2-rPt7ffe�5�6? _ worksheet review with the facility's Class A or 6 <br /> _ Qeerator. <br /> Print Name_ �/� , Print Na : b <br /> Signature: 4�14zg�k x % � <br /> Signatu <br /> Date: /V - ✓�'--' C7 Date: OAffl,7 <br /> MAINTAIN THIS DOCUMENT UN-SITE <br /> Rev.9/19/2016 <br />