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UST Training,Ben Thomas,Instructor <br /> Ground FedEx Ground Class C Operator 3495 Daisy lane,Clinton wA!38236 <br /> 866-301-826Swww-USTtraining-cam <br /> UST Facility Specific Worksheet <br /> Facility Name: / UST Facility ID# 153 <br /> Facility Address: f,lJ " <br /> Worksheet Instructions: <br /> • The Class C Operator must complete the required on-site training fQ110Mng completion of the Class C online <br /> training course (ENV-905)- <br /> • Class C Operatormust complete all training prior fo assuming responsibility for response to emergencies <br /> relsted to a spill or release of a regulated substance at the facility <br /> • Class A or B training provider and Class C Operator crust sign to verify that " ' has been completed.a <br /> Information to be reviewed by the Class A or B Operator: 0c , 2/"201l <br /> Iden Review the following information: <br /> 1/1 Location of Emergency Shut-of Switch Tank Monitor location, types d ��gj l LTH <br /> when there is an alarm DEP°ART3 M NT <br /> Over-fill Alarm ,/ On-site Spill Response Procedures ENV-401 <br /> Dis anser EmeL2ency Contact Information SPCC Poster <br /> `l Hose Location of Posted Emergency Contact Information: <br /> .:ti Noa1e Locatlon of fuel dispensing,permit this permit must be in <br /> place to authorize selF$eFOce <br /> Breakaway Coup] When it Is appropriate to call`911" <br /> Fuel island drainage path in case of a Who to contact for non-emergengy incidents <br /> significant spill(see SPCC Site Plan) <br /> _ That the delivery driver shall not remove a red tag at the <br /> Till pipe of an under round tank <br /> Signage at the fuel isfarnd Fuel system defects that should be reported to <br /> inane ement'. <br /> Fuel Island Spill Su ries&contents Slow flow at the nozzle <br /> Location of fire extin uishers Broken hose <br /> Communication system Damaged nozzle <br /> ****'*A CLASS C OPERATOR VUST BE ON srrE AT Ai,L TIMES DURING NORMAL OPERATING HOURS'"""* <br /> Class A or B Operator Class C Operator <br /> By my signature below, 1 certffy that I have provided By my signature below, t certify teat 1 have received <br /> the onsite training covered by this worksheet with the and completed the required Class C training and this <br /> named Class C Operator_ dr7worksheet review with the facility's Class A Or B <br /> Operator. <br /> Pdnt Name: 04'ale/r'l ur ,�°r Print Name: i [7r_ <br /> Signature: Signature: I <br /> Date_ n nDate: 10 .5 � <br /> MAINTAIN THIS DOCUMENT ON-SITE <br />