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C_J <br />CA DO Emp lirmvq Cnhlatt.=+s <br />Rev. b105 <br />Designated Operator Employee Training Checklist (page 2) <br />Station Name & Site Number Date ' <br />Employee Name ' c <br />Lar ge Spill Response Procedures <br />22.) Exp!a1n toe the d917fion all a lar e s <br />231 Ex0am ( procedure if Wil looks like it coUd leave iris pro <br />24.) Share where SMI"goncy r®portingtiong numbers are lix;ated <br />26.) ical show ornt.ftigrea the location o4 storm drams and craw to dn+ert spit !lows of necessary <br />26.) Explain OW em is to Clift in anis report Wiffs to A= al Valero Corpmale Office <br />Store Manager Ont <br />27.t Store Manager is responsible to evaluate hazardma waste materials generated from a large spilt and <br />contact Juilie Johm 0 660.683-3281 for coot"lion of dispa9al <br />Errner enc Respanse and Evacuation imp viiiials <br />28,) In ttl9owl of afire, far ypfa, or eadtituake. explain tww eech cert impact Ine station <br />29 ) Show as meVW$ available to SW dre 11" of fuel snot off bullarr caoate. breakers) <br />30.) Review "atatarr9'Emer Response Phut' mated in the stations O&M EinCer <br />31.) Physiostiowemployee Ioca on of oft arse evacual O t ms"22 spot for em ores <br />My Signature certifies that I have trained this employee in accordance with applicable <br />Designated operator regulations and covere all 'Hems on this training checklist. <br />Designated operator Signature <br />Date r~ <br />My signature certifies that i have received training regarding UST Monitoring and <br />Automatic Tank Gauge alarm procedures, spill clean up, and my station's <br />emergency response and evacuallo�n pll�an. (' 11 <br />Employee Signature ��Wf►taac_. /� �.�.. <br />ease�f�• LLbA-..—..... <br />(1) Copy in Station O&M Binder / DO tab <br />(1) Copy to employee <br />(1) Copy to Designated Operator / Area Manager <br />2 <br />1-1 <br />E <br />C <br />£0 39Vd 083 -)VA LL£LLb60Z ££:£S 800Z/6Z/L0 <br />