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06/25/2012 00 .05 #0379 P. 006/007 UST j Rev.o�arx>ps Facility ID . I O ERA70RS i PF i-618 I I Training Acknowledgement Form TWO Emilio ee" Hazardous Mals Trabin .. Pilot/Flying"J"#618 1501 Jack Tone Rd., Ripen, CA 95366 FE Initials if Rsviev,ed Com�e ex editionshas. d with FE 1 The FE can locate and describe tank and piping systems as well as monitoring equipment The FE can i Monitoring System Check and Alamo Res explain the Daily Response rpquiremeru�and s competent in completing these forms. 2- The FE can define which materials at the facility are hazard"and what makes them hazardous_The FE can describe where and how these materials are stored. 3.V i The FE can describe how these materials are to be handled, red and disposed of_The FE can explain the compatibility Issues regarding the storage of hazardous waste.The FE can describe basic regulations regarding the storage of Hazardous Waste,. The FE can describe the purpose and can complete and i nstal I the Hazardous Waste Label_The FE can explain the regulations regarding the'Start Date'and accumulation time nods of hazardous waste.The FE can demonstrate competence in completing the Hazardous Waste lrnpection C iecklist The FE can describe the purpose of the Material Safety Data heets(MSDS)and where this information is available_The FE can describe basic information available in the MSDS and heir purpose in the event of emergency_ Z, The FE can explain the purpose of the faality's Release Plan and can demonstrate knowledge about SpilV;eak q J resPwse C-OrSt case discharge'and'most likely discharge)including completing the facrilitys Spill Log- The FE can d'ifferen'tiate between'Recordable'souls and'Repdrtabie'spills and can describe the requirements of each. The FE can demonstrate cmnpetence in completing entries 0t the Spill Log. The FE can locate and demonstrate competence in the use of the sites'Spill Response Kit,The FE can describe types of ( materials niumled for a spill la as well as Personal Protective uipment(PPE)required_ The FE can indicate the location of emergency shut off switches and explain when they should be used.The FE can indicate the location of the facilities Fire Extinguishers and d e Competence in their use.The FE Can verbalize ' actions to be rrrade in the event of an emergency,ie,evacuation of persons to a safe location. 1 - The FE can explain Crow long tank system--relatad testing records and other documents should be kept by the facility f J (minimum three years in the binder or records repository,five years on site,for the lifetime of the tanks ofFs$e) Facility Empig yee Acknowiedgerrrsrt The Designate OPerator for my facility, identified below, has reviewed with the e responsibilitiesin keeping my facility's underground storagerated above concerning riming my roles and any local requi arts of the Certified Unified Program tank{UST)system In compregula ion at my midi UST regulations as we11 as og Agency{CUPA}enforcing these regulations at my facility. I understand z Id accept the duties and responsibilities that I am expected tc perform with regard to my facWs Monitoring Plan and Release Rei&p nse Pian. These include implementation of facility best Management practices, response to monitoring system alarms. response to ills at the fueling islands or overfills at the tank pad, contactin, identirhed emergency contacts in the event of a spill or release of p ct and the proper documentation of these activities. I have asked z ry questions 1 may have had Concerning these expectations urtt I was satisfied I understood them_I understand that I am responsible in Vhole or in part for maintaining the required LIST compliance documents for my station.I will ensure that these records will be kept in 'dance with irtst uc bons provided to me by the CUPA having juroiobon over my station. I/ I aciF4 Employee Name(Please Print) FE Signature and Date Trained by. u c Fa �Narne D Signature, Intemationai Cade Council(ICC)Certification# confirmation of FE refresher training and Expiration Date