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DISOENSING PROPANE SAFELY Check TA Applicable Dispenser Operator TRAINING CERTIFICATIONS Training CerUticatians [J Cylinder Exchangeiaries Suburban itsAffifiates Customer Training Agreements and Training Instructions for Dispenser Operator's 1 Cylinder Subsi• "COMPANY" Exchange Personnel / Customer's Employees /Agents ... _SHEET 'I OF 7 C0S-OVER; DISPENSER OPERATOR NAM-e•;'CL&70V.ER7 &a 97,? -/(54 re A Soot-) s �� --' j 19i CIT S-a.T=_ IIP GE tTiFICATION $Y.CUSTOMER'S-PERSONN€L J DISPENSER OP TOWS PERSONNEL OF RECEIPT OF TRAINING BY SIGNING BELOW, EACH UNDERSIGNED EMPLOYEE / AGENT OF THE ABOVE NAMED CUSTOMER CERTIFIES THAT HE / SHE HAS RECEIVED TRAINING FROM THE COMPANY INSTRUCTOR IN THE PROPER PROCEDURES TO USE, INSPECT, FILL, HANDLE: CONNECT, OPERATE, STORE AND/OR TRANSPORT LP -GAS AND LP -GAS CONTAINERS. AND THAT HE/SHE UNDERSTANDS ALL INSTRUCTIONS INCLUDING EMERGENCY AND FIRST AID PROCEDURES: NAME SIGNATURE AND DATE TITLE 3 4--C c, �� 10I21- MOV'_ For additional Employees 1 Agents trained (d through 20), complete thlKattached SHEET 2 of 2 (see track of document). Ei FRTYP1= OF 171SPEN51i�G - Froin.'DispensiR ' Propane Safely Training` Diagram (R1, R21 etc.): P!It1SPENSING PROPANE SAFELY-TRAIN)AiG::PECRMED - Enter a checkmark ®fo�ach training modal® completed M07 1 — Introduction I 000,LE 2 — Properties and Chars dsbos of Propane QDULE 3 — Dispensing Station Equipment DOT Cylinders 5 — Inspecbrig, Filling, and fall Cylinders 1'i�IORULE G — Refueling, Maintaining, and Troubleshooting Forklift Cylinders 7MODULE 7— Refueling ASME Motor Fuel and RV Tanks ❑MODULE S — Emerging Technologies ❑ MODULE 9 — Retail Cylinder Exchange Operations CUSTOMER'f. DISPENSER OPERATOR ACKNOWLEDGEMENT 1 AGREEMENT CUSTOMER ! DISPENSER OPERATOR ACKNOWLEDGES AND AGREES TO: ■ Receipt of the Company's Dispenser Operator Training Package, which includes PERC's "Dispensing Propane Safely" training program. ■ Use and fallow the DISPENSER OPERATOR AND PROPANE CYLINDER EXCHANGE TRAINING INSTRUCTIONS printed on the reverse side of this form as the standard operating procedures for all training. • Be responsible to train, or cause to be trained, all Employees I Agents in the proper procedures for handling LP -Gas and LP -Gas containers. • Not atlow Employees / Agents to use, inspect, flI's, handle, connect, operate, store and/or transport any LP -Gas or LP -Gas container until property trained as outlined in the DISPENSER OPERATOR AND PROPANE CYLINDER EXCHANGE TRAINING INSTRUCTIONS printed on the reverse side of this form. ■ Contact the Company or other LP -Gas equipment supplier to request materials or assistance, if needed, to Conduct all such training. • Installation of Signs and Decals in a proper and conspicuous place- . Maintain such Signs and Decals in readable format and to purchase and install, as needed, additional, replacement andlorSpanish language Signs and Decals from the Company or any LP -Gas equipment supplier. TRAINING CERTIFICATION BY.SUBURBAN I, THE UNDERSIGNED COMPANY INSTRUCTOR, CERTIFY THAT I PROVIDED TRAINING IN THE PROPER PROCEDURES TO USE, INSPECT, FILL, HANDLE, CONNECT, OPERATET STORE AND/OR TRANSPORT LP -GAS AND LP - GAS CONTAINERS-. .. ANY I.N WOR'S SIGMA T UR CG\1PAN'Y FFCIL;TY C:A1dE AIiD LOCATIOP! NJM2cR COMPANY [NSTr2liCT 5 C1AM' O'1TLE COMPANY FAC;JTY 7E�pH(}NE N':IMBER, DATE 7 I*�1�� rev �7 `�� S c� t�►�G'iC �� ` 4 � �v-- � �/ DISTRIBUTION: AATE Gr ORIGINAL — SUBURBAN YELLOW or COPY — CUSTOMER SHEET 1 of 2 em'$}3354 $AF 5123-071