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USrTraining,Ben Thomas,Instn rtor <br /> ■ m 3495 Daisy lane,Clinton WA 98236 <br /> Ground 865-30].-8265 www.U5Ttraining.com <br /> FedEx Ground Class C Operator <br /> UST Facility Specific Worksheet <br /> Facility Name: UST Facility ID# I <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 training prior to assuming responsibility far response to emergencies <br /> related to a spill or release of s regulated substance at the facility. r <br /> • Class A or B training prodder and Class C Opera for must sign to verify that si?fain as been completed. <br /> Information to be reviewed by the Class A or B Operator: Vol <br /> ldenti : Review the fol lowing information_ <br /> Location of Emergency Shut-off Switch V1 Tank Monitor location, types of atarrris and Who to call when there <br /> is an alarm <br /> Over-fill Alarm an-site S ill Response Procedures ENV-401 <br /> Dispenser Emergency Contact Information SPCC Poster <br /> Hose Location of Posted Emergency Contact information <br /> Y Nozzle Location of fuel dispensing permit this permit must be in place to <br /> authodze self-service <br /> Breakaway Coupling When it is appropriate to call"911' <br /> VFuel Island Drainage Path in case of a Who to contact for non-emergency 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 /> an under round tank <br /> Signage at the Fuel island Fuels stem defects that should be reported to mane ement <br /> Fuel Island Spill Supplies&Contents Slow flow at the nozzle <br /> Location of Fire Extin uishers Broken hose <br /> Communication System Damaged noz7Je <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, f certify that 1 have provided By my signature below, 1 certify that l have received <br /> the on-site training cowered by this worksheet with the and completed the required class C training and this <br /> namedClass C Operator. „ worksheet review with the facility's Class A or B <br /> Operator. <br /> Print Name: Print Print Name: Y A u <br /> Signature: Signature: (i7 <br /> r <br /> `�. Date: /62 017 Date: IV- <br /> MAINTAIN THIS DOCUMENT ON-SITE <br /> Rev.9/1912416 <br />