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U�5`T�T7ralning,Ben Thomas,Instructor <br /> Fe&xqp <br /> 3443 Daisy lane,alnton WA 98236 <br /> Ground 86&-301-$265 www,USTbaining.com <br /> FedEx Ground Class C Operator <br /> UST Facility Specific Worksheet <br /> Facility Name: �/,. <br /> UST Facility Id# <br /> Facility Address: <br /> Worksheet Instructions: - <br /> • The Class C Operator must complete the required on-site training following completion of the Class C online <br /> training course(ENV-105). <br /> • Class C Oparator must complete alt training prior to assuming responsibility for response to emergencies <br /> related to a spill or release of a regulated substance at the facility <br /> • Class A or B training provider and Class C Operator must sign to verify that#11 linin d inn com <br /> ,�w <br /> Information to be reviewed by the Class A or B Operator; 0 IT 2/* <br /> 2* <br /> Identi , Review the followino information: <br /> Location of Emergency Shut-off Switch Tank Monitor location, types ofa��'Tm to e;lllax r there <br /> is an alarm <br /> Oyer-fill Alarm On-site Spill Response Procedures ENV-401 <br /> DIS ens6r <br /> Emergency Contact information SPCC Poster <br /> Hose Location of Posted Emergency Contact Information <br /> Nozzle Location of fuel dispensing <br /> l� cpermitpeIt this permit must be in place to <br /> authorize self-serviceIET <br /> RreakqVpy Coupling When it is appropriate to call"911" <br /> Fuel Island Drainage Path in case of a Who to contact for non-emergency incidents <br /> significant spill(see SPMEmergency <br /> L',r Response ERP Site Plan) That the do]ivery driver shall not remove a red tag at the fill pipe of <br /> an underground tank <br /> Signa22 at the Fuel island " Fuels stem defects thW should be reported to management <br /> Fuel Island Spill Supplies&Contents � Slow flow at the nozzle <br /> L Location of Fire Extinguishers `J Broken hose <br /> Tu I Communication System Damaged nozzle <br /> ""*"A CLASS C OPERATOR MUST BE ON WEAT ALL TIMES DURING NORMAL OPERATING HOUR$"*'** <br /> Class A or B Operator Class C Operator <br /> By my signature below, 1 Certify that!have provided By my signature below, 1 ce,r*that!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. C e tr C worksheet review with the facility's Class A or B <br /> Operator <br /> Print Name:, Print Name: <br /> Signature: Signature: <br /> Date- e2 Date, <br /> 10 y { J <br /> MAINTAIN THIS DOCUMENT ON-SITE <br /> Rev.911912416 <br />