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06/25/2012 00:34 #0379 P. 002/007 <br /> Rei.UvaM <br /> UST Facility I[) <br /> r <br /> O ERATORS PFJ-618 <br /> C! C�lJW1O1N <br /> Training Acknowledgement Form <br /> "Faci!' Em oyee" Hazardous MaWals Trainin <br /> Facility Ef-ipi oyee(FE) Narne --- Facility Name and Address Tra_ining Date <br /> (Q� Pilot/ Flying"J"#618 <br /> SGO ll Q PtrV01501 Jack Tone Rd., Rip( n, CA 95366 1-2 3- /Z— <br /> PE 11111fials <br /> Z—FE!<ifials if <br /> Raviewed Compiwm Bveclai6ons has Revievwd vAh FE <br /> 1.The FE can locate and describe tank and piping systems as I vell as monitoring equipment The FE can e)q)lain the Daily <br /> Monitoring System Check and Alarm/Response requirements and is competent in completing these forms. <br /> 2.The FE can define which materials at the facility are hazardoeS and what makes them hazardous.The FE can describe <br /> where and how these materiais are stored. <br /> 3_The FE Can describe how these materials are to be handled, ed and disposed of_The FE Can exm <br /> plain the copatibility <br /> issues regarding the storage of hazardous waste.The FE car,describe basic regulations regarding the storage of <br /> Hazardous Wastes. <br /> 4.The FE can describe the purpose and Can complete and ir4U 11 the Hazardous Waste Label.The FE Can explain the <br /> regulations regarding the'Start Date'and accumulation time I eriods of hazardous waste.The FE can demonstrate <br /> competence in completing the Hazardous Waste inspection heckiist <br /> 5.The FE can desptbe the purpose of the Material Safety Data Sheets(MSDS)and where this information is available_The <br /> FE Can describe basic information available in the MSDS and their purpose in the event of emergency. <br /> 6.The FE can explain the purpose of b)e facility's Release Response Plan and can demonstrate knowledge about spilVleak <br /> response('worst case discharge"and'most likely dischargel including completing the facility's Spill Log. <br /> 7. The FE can differentiate between`Recordable'spills and'Reportable'spills and can describe the requirements of each. <br /> The FE can dernonstate Competence in completing entries ot rto the Spit]Log. <br /> 8. The FE can locate and demonstrate competence in the use o the sites'SlerTl se Kit'_The FE can describe types of <br /> materials needed for a spill kit as well as Personal Protective quiprnent(PPE)required_ <br /> 9.The FE can indicate the location of emergency stun Off and e)Vain when they should be used.The FE can <br /> indicafje the location of the facilities Fire Extinguishers and da nonstrate tarnpetence in ttwir use.The FE can verbalize <br /> actions to be made in the event of an emergency,ie.evaoigh>n of persons to a safe location- <br /> 0. <br /> The Fly can explain how long tank systerm-related testing records and other documerds should be kept by the facility <br /> (minimum three years in the binder or records repository,five ears on site,for the lifetime of the tanks Offsite). <br /> Facility Emp oyao Acknowlecigernent <br /> The Designa Operator for my facility, identified below, has reviewed with ne the expectations noted above concemi <br /> responsibil- in keepingfoci s underground story tank(UST)s in my rotes and <br /> my � rig 9e Complrartce with California'sCalrfomia's UST regutatiors as well as <br /> any karat"t irements of the Certified Unified Program Agency(CUPA)enforc ng these regulations at ray taality. <br /> I understand and accept the duties and responsibilities that I am expected to perform with regard to my facility's Monitoring Plan and <br /> Release R rise Plan_These include impberientabdon of facility best marupernent pmcbcn, response to mondoning system alarms, <br /> response to at the fueling elanCIS or overfills at the tank pad identified emergency oontacts in the evem of a spill or <br /> release of prc Juct and the proper docurhentation of these acrivities- <br /> I have asked my questions I may have had conceming these expectatiom$urtil I was satisfied I understood them. I understand that I am <br /> responsible ir whole or in part for maintaining the required UST compliance merits for my station.I wig ensure fiat these records will <br /> be kept in rdance with instructions provided to me by the CUPA having ju over rimy station. <br /> cam, <br /> Facility Employee Name(Please Print) FE Signature and Date <br /> Trained by: <br /> LA 44 <br /> Fac lity&Name 1 60 Signature, international Code Council OCC)Cedificabon# <br /> confirmation of FE refresher training and Expiration Date <br />