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CALIFORNIA ON-SITE STATION TRAINING FORM <br /> ANNUAL REFRESHER TRAINING VERIFICATION <br /> Site Number ✓ I f Dealer 0 � 0 L 0 <br /> Street Address 3 x o x 0.m "--1- L Ctg G <br /> City,Zip Code 5 "b C'"*J, C4 <br /> Employee Name(Print) Pck rw 4■-d 't O <br /> I acknowledge that I have received and understand environmental compliance training in <br /> the following areas (please initial): <br /> Initial Date <br /> Hazardous Materials Management Hazardous Materials Management/Business Plan <br /> 1. Which materials at the station are hazardous f ZIi� <br /> 2. Where these materials are stored 0 <br /> 3. How these materials are to be handled stored,and dis used of20 os" <br /> 4.What Material Safety Data Sheets MSDS are and where they are kept at the station E=TF9 0 <br /> S.Training topics included in the HMMP, including review of MSDS and the emergency <br /> response plan <br /> Waste Management Procedures <br /> 1. Procedures in the service bay p1b <br /> 2. The correct mane ement for Rroducts in the station Pfb, 11 2916 6- <br /> 3. Proper labeling of wastes 21b 1 <br /> 4. The importance of manifesting or having a receipt for all hazardous materials that leave the <br /> site <br /> Spill and Leak Response(Spill Response Plan <br /> 1. Location of spill response equipment 0 <br /> 2. Location of spill or leak contact list,reporting rocedures 7 6 1 i 129L6 G- <br /> 3. Location of emergency fuel shut-off switch 1 2-glo 5 <br /> %0 — l5 —0221 e Z*6 <br /> Employee Signature Social Sec.Number ate <br /> Training verified by IT) <br /> Dealer/Instructor Date <br /> MAINTAIN THIS FORM THE ENTIRE TIME THE EMPLOYEE WORKS AT THE FACILITY 00959 <br /> r <br />