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Ruder <br /> Underground Storage Tanks (UST) — Designated Operators <br /> Loc.Code: Loc Address: City State Zip <br /> i0'7 <br /> Name d Title of Employee Completing Form: Phone No.: Date Form Completed: <br /> OPERATORS LISTED BELOW HAVE BEEN CERTIFIED AS UST OPERATORS BY A THIRD PARTY VENDOR,STATE AGENCY,OR <br /> STATE-SPECIFIC RYDER TRAINING PROGRAM. <br /> ► UST DESIGNATED OPERATOR REQUIREMENTS ARE STATE SPECIFIC. <br /> o A MINIMUM OF ONE RYDER EMPLOYEE OR ONE 3RD PARTY CONTRACTOR MUST MAINTAIN LEVEL A I B OPERATOR STATUS FOR EACH <br /> RYDER LOCATION WITH AN UST (I.E..CA AND CO STATES MAINTAIN ONLY 3RD PARTY CONTRACTOR LEVEL A(B CERTIFIED <br /> OPERATORS) <br /> O AT LEAST TWO LEVEL C RYDER EMPLOYEES REQUIRED PER SHIFT. <br /> No. KEEP INFORMATION UPDATED AND CURRENT AS EMPLOYEES CHANGE. IF ANY OF THE ASSIGNED CLASS A,B,OR C <br /> OPERATORS LISTED BELOW TRANSFER,RESIGN,OR CHANGE RESPONSIBILITIES,NEW OPERATOR(S)MUST BE ASSIGNED <br /> WITHIN TEN DAYS AND MAY REQUIRE A,B,OR C CERTIFICATION TRAINING OR RE-CERTIFICATION. <br /> ► RYDER FUEL SERVICES IS RESPONSIBLE FOR HIRING 3RD PARTY CONTRACTORS,MAINTAINING ANNUAL RE-CERTIFICATION <br /> TRAINING AND COLLECTING CERTIFICATION DOCUMENTATION. <br /> RYDER EMPLOYEES'PROOF OF CERTIFICATION MUST BE FILED IN THE MAINTENANCE/ENVIRONMENTAL GREEN FILE <br /> FOLDER LABELED"STORAGE TANK SYSTEM-CERTIFIED TANK OPERATORS". <br /> ► POST A COPY OF THIS COMPLETED FORM IN: <br /> 1. THE RYDER SHOP OFFICE AND <br /> 2. THE KIOSK ON THE SERVICE ISLAND. <br /> OPERATOR <br /> A MINIMUM O <br /> - i- <br /> • ONE .ER EMPLOYEE OR ONE -.PARTY CONTRACTOR <br /> MUST MAINTAIN LEVEL A/B OPERATOR STATUS FOR EACH RYDER LOCATION WITH AN LIST. <br /> (I.E: CA AND CO STATES MAINTAIN ONLY 3RD PARTY CONTRACTOR LEVEL A/B CERTIFIED OPERATORS) <br /> RYDER EMPLOYEE OR 3RD PARTY CONTRACTOR COMPANY NAME AND ADDRESS <br /> Eafcl 4ywk0yA 1_ 0/30 x1nes X,1e ► ► o's <br /> EMPLOYEE NAME FIRST SHIFT EMPLOYEE NAME SECOND SHIFT) EMPLOYEE NAME THIRD SHIFT) <br /> -3;A✓►s VoY)i 1,dza4,)o <br /> t k-trim <br /> A ►P A)tzrXo f <br /> IMMEDIATELY NOTIFY RYDER FUEL SERVICES OF ANY PERSONNEL CHANGES AT(compliance a@ryderfs.com)OR(888-793.7865-OPTION 3) <br /> ES-49(09/2011)—Page 1 of 1 Retention Period:5 years <br /> Green File Folder: Storage Tank System—Certified Tank Operators <br />