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UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD <br />For use by Unidocs 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: & J/ (2 A �_v e -,Z) •� <br />Facility Site Address: � 1 � . "lex L �f v City: L. v' o' <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. The initial training must be provided within 30 days of the date of hire. This <br />training must be provided every 12 months. At least one of the facility employees present during operating hours must have <br />current training. This training must include, but is not limited to, .the following items as specified in 23 CCR Sections <br />2715(f)(1) and (2): <br />,4 Operation of the. UST system in a manner consistent with the facility's Best Management Practices-, <br />AM The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; <br />10 The employee's role with regard to spills and overfills as specified in the written UST Response Plan; <br />J21 Name(s) of contact person(s) for emergencies and monitoring equipment alarms; <br />23 CCR § 2715(f)(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 Employee Name <br />Training Date <br />Hire Date <br />Trainer Name <br />till I <br />r <br />90 <br />�Cr 9 n nn�A. <br />F�UIQt�R6R���IT41_1-IQ� <br />,�� p <br />Utt'Ni� <br />(Continued on reverse) <br />UN -061-1r www.unidomorg 07/13/05 <br />