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CA tO EMP T'aiMn, Chnirt 1.X79 <br />Rev.01M <br />Designated Operator Employee Training Checklist (page 2) <br />Station Name & Site Number Date o <br />Employee Name a <br />Itifth <br />Large Spill Res cnss Procedures E"'p <br />22.) Exp!sin tint the definition of a far spill <br />23.1E r adore it 1t looks kke d could Ioave Uto property <br />24)s where er»ar r® ni phone Wombats ars bcatt� <br />25.) lief chow a ee Uta kxation of an storWt tlrams and ttovr t0 dawn tdpill flows it nacai4a <br />26.) E en Nit ern is to call m and re s to RCSC a6 Yalero Carpo ale pillet <br />Store Mane er Qnl <br />27.} Stara is r to ®valuato hAzardotxS waste enatenals generated trap a large spill orb .a <br />contact Jure JphW4 ® s5a583-3251 fw coordination of diRL3al <br />Eme envy Response and Evacuation 5"'f' uwab <br />26.) to iM event of a lice. large spill or saWNt,wke, explain how each can lrnpact the station <br />29.) Show all rneftds available to aloe the flow d luef (shut 00 button console, ®re*ers) <br />30.) Flaview the stslbn$ 'EmErgoicy rwsponsa Pian' Dated in the stations ow Binder <br />e location of oft sats evacuation moelfR WXA fa" em)itoyass <br />i'. TM <br />My signature certifies that I have trained this employee in accordance with applicable <br />Designated operator regulations and covered all items an this training checklist. <br />Designated Operator Signature iW-GfG�.a,df <br />Onto <br />My signature certifies that t have received training regarding UST Monitoring and <br />Automatic Tank Gauge alarm procedures, spill clean up, and my station's <br />emergency response and evacuation pi n. <br />Employee signature • _ .. <br />1-1 <br />(1) Copy in Station O&M Binder / DO lab Alak <br />(1) copy to employee <br />(1) Copy to Designated Operator i Area Manager <br />Z0 39Vd 083-IVA TTELL060Z 65:ET 800Z/6Z/L0 <br />