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UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD <br />For use by Undoes Member Agencies or where approved by your Local Jurisdiction <br />Authority Cited: Title 23, Div. 3, Ch. 16 California Code of Regulations (CCR) <br />Facility Name: A 11 e /'1 r V, ; 41,z- + C,:? r lc <br />Facility Site Address: 2 S _ `_� S . �a v.� a,, (Z� city: <br />Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators <br />provide training to facility employees who have responsibilities associated with the operation and/or maintenance of <br />underground storage tank (UST) systems. This training must be provided by July 1, 2005, and every 12 months thereafter. For <br />facility employees hired after July 1, 2005, the initial training must be provided within 30 days of the date of hire. At least one <br />of the facility employees present during operating hours must have current training. This training must include, but is not <br />limited to, the following items as specified in 23 CCR Sections 2715(f)(1) and (2): <br />F Operation of the UST system in a manner consistent with the facility's Best Management Practices; <br />Qi The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; <br />t' The employee's role with regard to spills and overfills as specified in the written UST Response Plan; <br />❑ Name(s) of contact person(s) for emergencies and monitoring equipment alarms; <br />❑ For facilities that are not routinely staffed, facility employee responsibilities as specified in the training program <br />approved by the local UST regulatory agency. <br />23 CCR § 2715(0(3) requires that a list of employees who have been trained by the Designated Underground Storage Tank <br />Operator(s) be maintained on-site, or off-site at a readily -available location if approved by the local agency and provided to <br />the local agency upon request. Completion of this form will satisfy UST training record keeping requirements. The following <br />employees have been trained as required by 23 CCR Sections 2715(f)(1) and (2): <br />Facility Em to ee Name <br />Training Date <br />t7-3-ZS—/7 <br />Hire Date' <br />Zd /Z <br />Trainer Name2 <br />eulide/o , <br />Cva01w C _get e 4 e �- <br />�✓K <br />iLJI_ 12017 <br />ENITAL <br />DEF,Ar ��:eT <br />(Continued on reverse) <br />' If hired after July 1, 2005. <br />Z Trainer must be a current Designated UST Operator for the facility at the time of training. <br />UN -061 - U2 www.unidocs.org <br />07/13/05 <br />