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06/25/2012 00:34 10379 P 003/007 Rev.aw9r UST Facility ID C ERATORS PFJ-618 .. �.,RRS Training A *nowled- yement Form "Favi!' Employee" Hazardous M 'als Training HIM M 1124110-GIT Pilot/Flying V#618 Al 01�W, 1501 Jack Tone Rd-, Ripon, CA 95366 j � 1(;� tIM:rI . . .. . . - rM I turas Raviewed wilh FE 1. The FE can locate and describe tank and piping systems a5 woeff as monitoring equipment.The FE can explain the Daily Monitoring System Check and Alamm/Response requirerrienriz and is competent in Completing these fomes. 2-The FE Can define which materials at the facility are hazardot s and what makes thern hazardous-� The FE Can describe� where and how these materials are stored- 3- The FE can describe how these materials are to be handled, red and disposed of.The FE can expiatin the compatibility issues regarding the storage of hazardous waste.The FE can describe basic regulations J r Hazardous Wastes- nding the storage of 4-The FE can describe the purpose and can complete and insta I the Hazardous Waste Label.The FE can explain the Vii f t regulations regarding the`Start Date'and accumulation time p ariods of hazardous waste.The FE can demonstrate f 1 competence in completing the Hazardous Waste fnspection fist The FE can describe the purpose of the Material Sa{ y Data Sheetr,(MSDS)and where this information is available.The FE can describe basic information available in the MSDS and r purpose in the event of emergency. VJ -The FE Can explain the Purpose of the facility's Release RespxIse Plan and can demonstrate knowledge about spilNleak L ✓�.(�] response("worst case disc'ttarge^and-most likely discharged including cornplE4irrg the facility's Spill Log- -The FE can differentiate betrween'Recordable'splls and' able'spills and can desoibe the requirernerds of each- The FE can demormstraUe competence in compietirmgentries o o ftSpill 109. -The FE can locate and demonstrate competence in the Live of si6eS`Spill Response Kir-The FE can describe hypes,of 1,✓1J, materials needed for a spill kit as well as Personal Protective quipmerd(PPE)required. y . The FE can indicate the location of emergency shut off swftclx 5 and e)piain when they should be used.The FE can indicate the kation of the facilities Fire Extinguishers and den onstrate Competence in their use-The FE can verbalize b {1 I actions to be rade in the event of an emergency,ie-evacuatic I of persons to a Sate location. 1 .The FE can explain how long tank system4alated testing recor Is and other dowmarits should be kept by the fatality I i (minimum three years in the binder or records repository,five yds on see,for the lifetime of the tanks offsite). Facilely E- Acitr.a *dgerr—it The Desig Operator for my facility, ederttified below, has revwAmed withthe expectations noted above concerning my roles and responsibil " in keeping my facility's underground storage tank(UST)sy&Zpxrin compliance with California's UST regulations as well as any kcal requ rernerrts of the Certified Unified Program Agency(CUPA)enforciig these reguLe ions atm Y fact fitY. 1 understand accept the duties and responsibilities that 1 am expected t perform with regard to my facility's Monitoring Plan and Release Plan. These include implementation of facility best mana gement practices, response to monitoring system alarms, response to s ills at the fueling islands or overfills at the tank pad, contac&g identified emergency contaCty in the event of a spill or release of pm uct and the proper documentation of these activities. I have asked y questions I may have had concerning these expectations un il 1 was satisfied I understood them.I understand that I am responsible in Nhole or in part for maintaining the required UST compliance is for my station.f will ensure that these records will be kept in rdance with i 5 proyided to me by the CUPA having ju M iction over my station. lily Employee Name(Please Pnnt) FE Signature and Date Trained by. FacO ty DO Narme, D ignature, International Code Council(ICC)Certification# confinmabon of FE refresher traininq and Expiration Date