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UST Training,Ben Thomas,Instructor <br /> � Ground FedEx Ground Class C Operator 3495 Daisy lane,Clinton WA 98236 <br /> 866-301-8265 www.USTtraining.com <br /> UST Facility Specific Worksheet <br /> Facility Name: UST Facility ID# <br /> Facility Address: 5665 W,-,j Way Ira c <br /> y Ch M77 <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 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 all training has been completed. <br /> Information to be reviewed by the Class A or B Operator: <br /> ld ritify Review the following information: <br /> Location of Emergency Shut-off SwitchTank Monitor location,types of alarms and who to call <br /> when there is an alarm <br /> Over-fill Alarm On-site Spill Response Procedures ENV-401 <br /> Dispenser Emergency Contact Information SPCC Poster <br /> Hose Location of Posted Emergency Contact Information: <br /> Nozzle Location of fuel dispensing permit this permit must be in <br /> place to authorize self-service <br /> Breakaway 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 SPCC Site Plan) That the delivery driver shall not remove a red tag at the <br /> fill pipe of an underground tank <br /> Signage at the fuel island ✓ Fuel system defects that should be reported to <br /> management: <br /> Fuel Island Spill Supplies&contents I Slow Flow at the nozzle <br /> Location of fire extinguishers 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, I certify that I have provided By my signature below, l certify that I 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. worksheet review with the facility's Class A or B <br /> Operator. <br /> Print Name: Print Name: _ I-u -3 <br /> Signature: WIG ignature: <br /> Date: Date: <br /> MAINTAIN THIS DOCUMENT ON-SITE <br />