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USTTnIning,Ben Thomas,Instructor <br /> 3495 daisy lane,Gunton WA 88236 <br /> Ground 866-301--8265 wNlW,U57training.com <br /> FedEx Ground Class C Operator <br /> UST Facility Specific Worksheet <br /> Facility Name: a JUST Facility ID# <br /> Facility Address_ , <br /> Worksheet Instructions: <br /> * The Class G Operator must complete the required on-site training following completion of the Class C online . <br /> training course(ENV--905). <br /> • Class C Operator must complete all training prior to assuming responsibility for response to emergencie.; <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 ail training has been compI. <br /> )C <br /> Information to be reviewed by the Class A or B Operator: Z 2017 <br /> 1�3u <br /> Iden Review the following information_ , WE; LTH <br /> Location of Emergency Shut--off Switch Tank Monitor location,types of alarms and who, <br /> is an alarm <br /> Over-fill Alarm Onsite Spill Response Procedures ENV-407 <br /> Dispenser Emergemy Contact Information SPCC Poster <br /> Nose Location of Posted Emergency Contact Information <br /> .Nozzle- ___.. � Location of fuel dispensing permit this permit must be in place to <br /> authorize self-service <br /> Breakaway Cou ling When it is appropriarte to call"911° <br /> Fuel Island Drainage Path in case of a Who to contact for non-em e en incidents <br /> significant spill(see SPCC/Emergency That the deliverydriver shall not remove a red t at the fit{pipe of <br /> Response ERP Site Plan) an underground tank p P <br /> Signage at the Fuel Island Fuels stem defects that should be re orted to management: <br /> Fuel Island Spill Supplies&Contents Slow flow at the nozzle <br /> Location of Fire Extln ulshers 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 El Operator (�- �r Mass C Operator <br /> By my signature below, 1 certify that l have provided By my signature below, l certify that l have received <br /> the on-site training covered by this worksheet with the and completed the required Gess C training and this <br /> named Class C Operator. worksheet review with the facility's Class A or B <br /> Operator. <br /> Print Name: .l �j� '� � Print Name: t) <br /> Signature- Sign <br /> �— �ALA <br /> Date: � ' .� <br /> [ Date: <br /> MAINTAIN THIS DOCUMENT ON-SITE <br /> Rev.9/1912016 <br />