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06/25/2012 00:34 90379 P. 005/007 <br /> Rei,.asgyrt00g <br /> r <br /> O ERATORS PFJ-61 S <br /> OL �ft-. <br /> Training A knowledgement Form <br /> "Facift Employee" Hazardous Wals Tonin <br /> L i n -6C CA-\C--X Pilot/Flying "J"#698. - <br /> 1501 Jack Tone Rd_, Ripen, CA 95366 <br /> FE Initials if <br /> i C-ripfiance Eimmecubons I has FUiawad wah FE <br /> t- The FE can locate and describe tank and piping systems as II as monitoring equipment.The FE can explain the Dairy <br /> Monitoring System Check and Alarm!Response requiremerits and is competent in completing these forms, <br /> r illi <br /> 2.The FE can define which materials at the facaity are hazard o I and what makes them hazardous.The FE can describe <br /> where and how these materials are stored. <br /> 3.The FE can describe how these matefials are to be handled,i lored and disposed of The FE can explain the compatibility <br /> issues regarding the storage of hazardous waste.The FE can desmbe basic regulations regarding the storage of <br /> Hazardous Wastes. <br /> The FE can describe the purpose and can comple a and insta I the Hazardous Waste Label.The FE can explain the <br /> regulations regarding the-Start Date'and accumulation time pigriOC15 of hazardous waste,The FE can demonstrate <br /> competence in completing the Hazardous Waste Inspection 0 je&j ist <br /> - The FE can describe the purpose of the Material Safety Data heets(INSDS)and where this information is available.The <br /> FE can describe basic information available in the MMS arid beir purpose in the event of emergency. <br /> The FE can explain the purpose of the faplity s Release Response Plan and Can demonstrate knowledge about sptlUleak <br /> response(worst Case discharge and'mast likely discharge`) ncluding Completing the facility's Spill Log. <br /> 7.The FE can differentiate between'Recordable'spills and' Spits and Can describe the requirements of each. <br /> The FE can demonstrate competence in compl�ng entries o o tate Spill Log. <br /> The FE can locate and demonstrate competence in fhe use of�sites'Spill Response KrY_The FE can describe types of <br /> materials needed for a spill kit as well as Personal Protective Fquiprnent(PPE)required. <br /> i <br /> The FE can indicate the location of emergency shut off and explain when they should be used The FE can <br /> iridicate the location Of the faaTdies Frye Extinguishers aide competence in their use_The FE can verbalize <br /> actions to be made in the event of an emergency,ie.evaCuati of persons to a safe location. <br /> 1 _The FE can explain how long tank systern-rekded testing records and other doamients slwuld be kept by the facility <br /> (minimum three years in the binder or records repository•five rs on site,for the frhetime of the tarries off 4--). <br /> t IitY Ertl yea Acknowk4gertreret <br /> The DesWvw Operator for my facility. iderrhified below,has reviewed with the expectations noted above concerning my roles and <br /> responsibil in keeping my facility's underground storage tank(UST) in compliance with California's UST regulations as well as <br /> any kical requ ents of the Certified Unified Program Agency(CUPA)enford g these regulations at my facility. <br /> I understand nd accept the duties and responsibilities that I am expected t perform with regard to my fadlity's Monitoring Plan and <br /> Release R rise Plan. These include mplenierrtatiort of facility best man ement practices, response to monitoring System alarms, <br /> response to ills at the fueling islands or overfills at the tank pad, co,tthCti idenffied emergency contacts in the event of a spirt or <br /> release of p Lict and the proper documentation of these activities. <br /> I have asked o iy questions I may have had conce-ming these expectations until I was satisfied I understood them.I understand that I am <br /> responsible in vhols or in part for maintaining the required UST Cartiplianoe ments for my station. I will ensure that these records will <br /> be kept in dance with irons provided to me by the�CUPA having j ion my n. <br /> �� P �r jam- � •�- <br /> acltdy�nploym Hanle(P Prim) ; E Signatu rid Date _ <br /> Trained by. /- <br /> / > a U <br /> F DO Name grratura, International code Council(ICC)Certification# <br /> confirmation of FE refresher trai and irahm Date <br /> i <br />