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UNDALROU(N—DIT RAGE TANK IPSTEM <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, Div. 3, Ch. 16 California Code of Regulations(CCR) <br /> Facility Name: I <br /> Facility Site Address: Ain k), 0 a­ L-, City: <br /> Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators <br /> provide training to facility employees who have responsibilities associated with the operation and/or maintenance of <br /> underground storage tank(UST)systems.This training must be provided by July 1,2005,and every 12 months thereafter. For <br /> facility employees hired after July 1,2005,the initial training must be provided within 30 days of the date of hire. At least one <br /> of the facility employees present during operating hours must have current training. This training must include, but is not <br /> 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 person(s)for emergencies and monitoring equipment alarms; <br /> 0 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§2 7 1 5(f)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank <br /> Operator(s)be maintained on-site,or off-site at a readily-available location if approved by the local agency, and provided to <br /> the local agency upon request.Completion of this form will satisfy UST training record keeping requirements.The following <br /> employees have been trained as required by 23 CCR Sections 2715(f)(1)and(2): <br /> Facility Employee Name Training Date Hire Date' Trolner Name2 <br /> P. �L>VA <br /> ff <br /> (Continued on reverse) <br /> If hired after July 1,2005. <br /> 2 Trainer must be a current Designated UST Operator for the facility at the time of training. <br /> UN-061-1/2 www.unidoes.org 07/13/05 <br />