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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, 1Div. 3, Ch. 1�6,Cali\\fornia Code of Regulations(CCR) <br /> Facility Name: �.'C �F n l\� ,/ —1- ` <br /> Facility Site Address: ;LL 1�� g/7 L iovC fir ' City: <br /> Section 2715 of Title 23, California Code of Regulations,requires that Designated Underground Stor4e Tank Operas <br /> provide training to facility employees who have responsibilities associated with the operation and/or maims <br /> underground storage tank(UST) systems. This training must be provided by July 1, 2005, and every 12 moNhs theted <br /> For facility employees hired after July 1, 2005,the initial training must be provided within 30 days of the date of hire. <br /> least one of the facility employees present during operating hours most have current training. This tmimng must include, <br /> is not limited to,the following items as specified in 23 CCR Sections 2715(f)(1)and(2): <br /> ❑ Operation of the UST system in a manner consistent with the facility's Best Management Practices; <br /> ❑ The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; <br /> ❑ The employee's role with regard to spills and overfills as specified in the written UST Response Plan <br /> ❑ Name(s)of contact persons)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(f)(3)requires that a list of employees who have been trained by'the Designated Underground Storage Tar <br /> Operator(s)be maintained on-site,or off-site at a readily-available location if anoroved by the local agency and provided <br /> the local agency upon request Completion of this form will satisfy UST training record keeping requirements.The follovi <br /> employees have been trained as required by 23 CCR Sections 2715(1)(1)and(2): <br /> Facility Employee Name Trainin Date 1Trre Dater r Name <br /> 1 rN _ ( L. <br /> z 2- <br /> 2S'2S' Z <br /> ' _ ZS l2 Cup <br /> o -mss 2-P r a- ( wt <br /> 3$(,1 <br /> f <br /> j <br /> V t <br /> � TT (Continued on-reverse) <br /> If hired after July 1,2005. <br /> 'Ttaicer moat be a current Designated UST Operator forthe facility atthe lime of training <br /> =i <br /> ulv.ar-vz ' <br /> ww .®idocsore 0 <br />