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06/25/2012 00:34 #0379 P. 004/007 UST Facility ID rzr.a�o3rmaa D fttATORSPFJ`-618 Training Acknowledgement Form "Fall' Em ee" Hazardous Matoda!s Training Pilot/Flying V#618 " 1501 Jack Tone Rd., Ripon, CA 95366 - FE lrrtials If R owed oarrraanoe 6P-9CZWots had Re Vw rid wlh FE 1.The FE can locate and describe tank and piping systems as as monitoring equipment The FE Can Monitoring System Check and Alarm/Response requirements and is competente>slain the Dairy lo completing these forms. i 2.The FE Can define which materiat$at the facility are hazardo and what makes them hazardous-The FE can describe �• where and how these matenat$are stored. .The FE can describe how these materials are to be handled, ored and disposed of-The FE can eWain the compatibility • issues regarding the storage of hazardous waste.The FE can describe basic iii Hazardous Wastes. UWiom regard9 the storage of The FE can describe the purpose and can comptete and in the Hazardous Waste Label.The FE can explain the regubtions regarding the`Start Date'and aoaxnulatiOn timerinds of hazardous waste.The FE can demonstrate competence in completing the Hazardous Waste Inspection Clist The FE can descnbe the purpose of the Material Safety Data heet5(MSDS)and where this information is avaitable.The isc FE can dribe basic information available in the MSDS and it purpose in the event of emergency. The FE can explain the purpose of the facility's Release Res Plan and can demonstrate knowledge about spill/leak . response(worst case discharge*and'most likely disctrarge-) nOWiag corMleft the facility's Soli Log- 'n1 The FE can tfdferentiate between'Recordable'spilt$and'Rejx 4tabielspills and can describe the mrequirements of each. 1, The FE can demonstrate Competence in cpnp{ebn9 ent les o ft Spill Log-1. The CCC FE Can kx ate and demOrl5bate Comp-&--I--in the use Of i he sib `Spill Response KiC.The FE can describe types of materials needed for a SON kit as welt as Personal Protective Equipment(PPE)required- The FE Can indicate the location of emergency shut off and a gAain when they should be used_The FE can indicate the location of the facilities Fire Fxtirtguishers and dem Dnstrate oompet@Ke in their use.The FE Can verbalize actions to be made in the event of an emergency,ie,evacuatioo of persons to a safe location. (� 11 The FE can explain how long tank�testing recd and other documents should be kept*the fac y 11 (minimum three years in the binder or records repository,fnre years on site,for the lifietime of the tanks offsite). T� FaclFlty Em yea AClcnowladgerne,� The DesigriatE d Operator for my facility, ide ified below. has reviewed withthe e> tions notal above concerning my roles and n:$pO -nsb in keeping my fecifitys underground storage tank(UST)$ystemlin comp4ance with Califomia's UST regulations as weft as any local requi eats of the Certified Unified Program Agency(COPA)anforcirig these regulations at my facility. I understand d accept the duties and responsibilities that f am e> 7 perforin with regard to my faciNtys Monitoring Plan and Release R nse Plan. These include implementation of facility best man practices, response to mptitoring systern aiam-o, response to Tls at the fueling islands or overfrlis at the tank pad, co identified emergency contacts in the event of a $ofl or release of p and the pr r documentation of these activi les. I have asked a questions I have had concerning these e*eGt !loris u I-as satisfied I understood them_I understand that I am resppt onsible in or accc-dance in for mai ni ed UST'compliance tl mentss for my station. I wil�ensure that these records will by t ju icon over my ( FE signature and Trained by: C- Facili y 60 Name ignature, IntematiOnal Code COtJnCrl(ICC)Certification# Confirmation of FE refresher training and iration Date