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LRERGROUND STORAGE TAJ+1t; Y S STEM DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23, Div. 3, Ch. 16 California Code of Regulations(CCR) Facility Name: ' Facility Site Address: normo jmd L44� City: s�_ 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 with the operation and/or maintenance of underground storage tank(UST)systems. This training must be provided by July 1,2005,and every 12 months thereafter. For facility employees hived after July 1,2005,the initial training must 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 must include, but is not limited o,the following items as specified in 23 CCR Sections 2715(f)(1)and(2): Operation of the UST system in a manner consistent with the facility's Best Management Practices; The employee's role with 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 the 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(f)(1)and(2): Facility Employee Name Training Date Hire Date' Tr4ier Name Z7 -7 1 /f q q q (3, r 51 u�(4 );Z_7)A/ 0 , >11'M �0 Au,�� 1,J73 j 6113 0 ,.. ouw low REM= �.► (Continued on reverse) 1 if hired after July 1>2005. N O V 0 4 2014 2 Trainer must be a current Designated UST Operator for the facility at the time of training. ENVIRONMENTAL HEALT} j 07/13/05 UN-obi-1t2 www.neidomorg DEPARTMENT