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UST Training,Ben Thomas,Instructor <br /> Ground FedEx Ground Class C Operator 3495ais/ y e,Clinton WA 98236 <br /> 866-301-8265 w .USTtrainingsom <br /> UST Facility Specific Worksheet <br /> Facility Name: 'Ft ey 6rno n A I UST Facility ID# <br /> Facility Address: 5(d55 16A (110-4 -Trokcij CA q6337 <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 8 Operator: <br /> Identi : Review the following information: <br /> Location of Emergency Shut-off Switch Tank 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) <br /> That the delivery driver shall rat remove a red tag at the <br /> FII i e of an underground tank <br /> Signage at the fuel islandFuel system defects that should be reported to <br /> Vmanagement: <br /> Fuel Island Spill Supplies&contents �/ Slow flow at the nozzle <br /> Location of fire extinguishers Broken hose <br /> Communications stem 7 Damaged nozzle <br /> " A CLASS C OPERATOR MUST BE ON SITE AT ALL TIMES DURING NORMAL OPERATING HOURS-- <br /> Class <br /> OURS'" —Class A or B Operator Class C Operator <br /> By my signature below, l 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 /> O erator. <br /> Print Name: Print Name: U n <br /> Signature: Signature: <br /> Date: -7 Date: ftV ' <br /> MAINTAIN THIS DOCUMENT ON-SITE <br />