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06/23/2012 00.33 90379 P. 001/007 <br /> PM.-03M <br /> UST Facility ID <br /> O ERRTORS PFJ -618 <br /> Training A knoedg <br /> iement Form <br /> Facia Em o <br /> ,q qe Hazardous midals Trainin <br /> Facility Employee Date <br /> Pilot/Flying V#61 a <br /> 1501 Jack Tone Rd., Ripon, CA 95366 <br /> Employee 7 <br /> Facility . Refresher Training Review <br /> FE trhittaks if <br /> Reviewmi CarlPFance Emottaabons has Reviewed with FE <br /> 1.TheF�E can locate and describe tank and piping systems as well as monitoring equipment The FE Can explain the Daily <br /> Monitoring System Check and Alarm/Response requireme and is competent in completing these form <br /> 2.The FE can define which materials at the facility are hazardoi is and what makes U►em hazardous.The FE can describe <br /> where and how thesse materials are stored. <br /> 3.The FE can describe how these materials are to be handled, Aored and disposed of.The FE can explain the compatibility <br /> issues regarding the storage of hazardous waste.The FE car i describe basic regulations regarding the storage of <br /> Hazardous Wastes. <br /> 4.The FE can describe the purpose and Can complete and install the Hazardous Waste Label.The FE can explain the <br /> regulations regarding the`Start Date'and accumulation time nods of hazardous waste.The FE can demonstrate <br /> competence in cgmpieting the Hazardous Waste Inspection Ghecklist. <br /> 5.The FE can describe the purpose of the Material Safety Data Sheets(MSDS)and where this kftmmation is available.The <br /> FE can describe basic information available in the MSDS and their purpose in tate event of ernergenk_ _ <br /> 6.The FE can explain the purpose of the facility's Release Reg onse Plan and Can demonstrate knowledge about spMeak <br /> respo*('worst Case discharge"and"most likely discharge7 inducing completing the facility's Spill Log, <br /> 7_The FE can differentiate between`Recordable'spills and'Ref ortable'spfis and can describe the raquirernents of each. <br /> The FE can den►onsbate oorrrpetence in complebng entries oirlo the Spill Log. <br /> 8. The FE can locate and demonstrate competence in the use o the sites`Spill Response Kit'.The FE can describe types of <br /> mate TIs needed for a spill kit as well as Personal Protective quipment(PPE)required. <br /> 9_The FIE Can indicate the location of emergency shut off switch as and explain when they should be used.The FE can <br /> irmdicaie the location of the facilities Fre Extinguishers and de rionsti-ate oompetffmue in their use.The FE can verbalize <br /> actions to be made in the event of an emergency.ie.evacu n of persorss to a safe location. <br /> 0_The FE can explain Prow long tank system related testing recc rd5 and other documents should be kept by the facility <br /> (minimum three years in the binder or records repository,five years on site,for the lifetime of the tanks offsite). <br /> Facility Em ee <br /> The Designa ed Operator for my facility, identified bek w, has reviewed with the expectations noted above Concerning my roles and <br /> responsib,ilb s in keep�ng my fadity's underground storage tank(L in compliance with Cahfomia's UST regulations as well as <br /> any kcal --- -is of the Certified Unified Program Agency(CUPA)onfort ng these regulations at my facility. <br /> I understand and accept the duties and responsibifib'es that I am expected o perform with regard to my faaWs Monitoring Flan and <br /> Release Req Donse Plan. These include impiernentation of facility best man igement pradjoes, response to monitoring system alarms, <br /> response to at tlhe fueling islands or overfilts at the tank pad, contact ig identified emergency contacts in the evert of a Spill or <br /> release of p uct and the proper documentation of these activities. <br /> I have asked any ques�Ons I may have had concerning these expectations oitil I was satisfied I understood them I understand that 1 am <br /> responsible i whole of in part for maintaining the required UST compliance d3cumwft for my station. I will a these records will <br /> be kept in ac rice with' provided to me by the CUPA having ju ittion77 <br /> f <br /> iQ ; i (tel G7 1—Z51-/1a! <br /> Facility Employee Name(Please Print) FE nature and Gate <br /> Trained by: <br /> SS ��- Cry <br /> Fa4 06ty Do Name Signature, International Code Council(ICC)Certification# <br /> confirmation of FE refresher training andEx iratian Date <br />