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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED OPERATOR FACILITY EMPLOYEE 'TRAINING RECORD For use by Urtidocs Member:4gencies or where approved by your.Local Jurisdiction .Authority Cited: Title 23, Div: 3, Ch. 16 California Code of Regulations(CCI Facility Navane: kJ S, —� T��I,,�d!�t� Z- L C .- .4/2 C a /} r", P/-;�1 _ Facility Site Address: l/ p s', m��,3 7. { Citys �c c 11- Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators provide training to facility employees who have responsibilities associated witb the operation and/or maintenance of underground storage tank(UST)systems. This training roust be provided by July 1,2005,and every 12 months thereafter.For facility employees hired after Juh, 1,2005,the initial training niust be provided within 30 days of the date of hire_At least one of the facility employees present during operating hours must have current training. This training trust include, but is,not limited to,the following items as specified in 23 CCR Sections 2715(f)(1)and(2): Operation of the LIST system in a manner consistent with the facility's Best Management Practices; The employee's role witb regard to UST monitoring equipment as specified in the written UST Monitoring Plan; The employee"s role with regard to spills and overfills as specified in the written UST Response Plan; Name(s)of contact person(s)for emergencies and monitoring equipment alarms; ❑ For facilities that are not routinely staffed,facility employee responsibilities as specified in the training program approved by the local UST regulatory agency. 23 CCR§2715(f)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank Operator(s)be maintained on-site,or off-site at a readily-available location if approved by thg local agency,and provided to the local agency upon request.Completion of this form will satisfy UST training record keeping requirements_ The following employees have been trained as required by 23 CCR Sections 2715(£)(1)and(2): Facility Employee Name Trai0in Date Hire Date Tr ner Name` � XAA ,I FZR0Z /4 E /+s NLey Z_a P&2_ SGlkffC3�.� �' L 2 3 !a (Conrinued on reverse) If hired after July I,2005. `ZYainer must be a cuxreot Designated us,r operator for the facility at the time of training, UN4)61 -1/2 www.unidocs.org 07/13/05