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JUN 0 3 easier ► = PFJ-617 Training Acknowledgement Form "Fac ployee" Hazardous MaWflals Training flity EMP s Pilot/Flying"J"#617 15100 Thomton Rd., Lodi,CA 95242 p? FE InItleb N Reviewed ComplienceMpmMonsDOheaftylavuedwithIFE /) 1.The FE can locate and descdbe tank and piping system as wall as monitoring equipmeaL The FE can explain the Daily Monftft System and AlamV Response requirements and Is competentin completing these forms. 2.The FE an deflne which materials at the facility are hazardous and what makes them hazardous.The FE an describe where and haw these materials are stored. 3.The FE an describe how them are to be handled,stored and disposed of.The FE can explain the compatibility issues regal the of h .The FE an regulationsng the of Hazardous 4.The FE an describe the purpose and an complate and install the Hazardous Waste Labet.The FE an explain the regulations regarding the'Start DeW and accumuladw time penods of hazardous waste.The FE can demonstno competence In co the Hazardous Waste Inspection 5.The FE an describe the purpose of the Material Safety Data Shaft(MSDS)and where this Information is available ( � FE can describe basic Information available In the MSDS and their purpose in the event of 6.The FE can explain the purpose of the facillys Release Response Plan and can demonstrate knowledge about spMftak response(%vofst me discharge"and"most likely discharge)6 s Spy Log. 7.The FE can differentiate between'RecordabW spills and can describe the requiramerds of each. The FE can demonstrate competence in completing entries onto the Spill Log. 8.The FE can locate and demonatrabs competence in the use of the Kit'.The FE can describe types of materials needed for a spill kit as well as Personal Protective Equiprnent )required. Lool g.The FE an indicate the location of emergency shut off switches and explain when they should be used.The FE an Indicate the location of the facilities Fire Extinguishers and demonstrate competence in their use.The FE an verbalize actions to be made In the event of an em envy,ie.evacuation of persons to a safe location. 10.The FE an explain haw long tank ng records and other documents should be kept by the facility (minimurn three years in the binder or records rapositM,fire yews on site,for the Notimir of the tanks offske). Facility Employee AckrAwledgement The Designated Operator for my facility,ldenMW below,has reviewed me the expectations noted above concemft my miss and responsibilities In keeping my IwWs underground storage tank(UST)system its compliance with CafffomWs UST regulation as wag as any local requirements of the CeMed Unified Program Agency(COPA)enforcing these regulations at my I understand and accept the duties and responsibilities that I am expected to perform with regard to my fikdWs Monitoring Plan and Release Response Pian.These Include Implemerdetion of facility beat management practices,response to monbft system alarms, response to spills at the fuelft ends or overfills,at the tank pad, contacting Identified emergency contacts in the event of a spill or relem of product and the pmper documentation of#was activities. I have asked any questions I may have hal concerning these expectations until 1 was satisfied 1 understood them.I understand that I am responsible In whole or In part for malrAsining the require!UST compliance documents for my station.I will on thase records will be kept i anus with Instructions provided to me by the CUPA having jurisdiction my Facility Employee, (P FE Signature and Date Trained by. Lance York 5296385-UC August 12, 2016 Facility DO Name 0 International Code Council(ICC)Certification# firmatlon FE her tralft and gpiratlon Data