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JUN 0 3 2016 • PFJ - 617 Training Acknowledgement Form Tac mployee" Hazardous Materials Training rs � i r C �. (:e Pilot5100 Than ton Rd.,Lodi,CA 95242 �-�'01114 ♦ es e FE if DO has RWWVAdwkhFE 1.The FE can locate and describe tank and piping Systems as well as monitoring equipment.The FE can explain the Daily Monitoring System Check and Alarm/Response requirements and Is competent in completing these forms. 2.The FE can define which materials at the facility are hazardous and what makes them hazardous.The FE can describe where and how these materials are stored. 3.The FE can describe how these materials are to be handled,stored and disposed of.The FE can explain the compatibility issues regarding the storm of hazardous waste.The FE can describe basic regulations regarding the storage of Hazardous Wastes. 4.The FE can describe the purpose and can complete and instal the Hazardous Waste label.The FE can explain the regulations regarding the Start Date'and accumulation time periods of hazardous waste.The FE can demonstrate competence in con the Hazardous Waste Inspection Checklist. 5.The FE can describe the purpose of the Material Safety Data Sheets(MSDS)and where this Information Is available.The FE can describe basic information available in the MSDS and their purpose In the event of emergency. 6.The FE can explain the purpose of the facility's Release Response Plan and can demonstrate knowledge about spillftak response Cwwst case discharge'and'most likely dechargel Including completing the facWs Spill log. 7.The FE can d 'Recordable'spills and' 'spills and can describe the requirements of each. The FE can demonstrate competence in completing entries onto the Spill Log. - The FE can locate and demonstrate competence In the use of the sites'Spill Response KIt'.The FE can describe types of materials needed for a spill kit as wen as Personal Protective Equipment(PPE)required. 9.The FE can indicate the location of emergency shut off swtdtes and explain when they should be used.The FE can Indicate the location of the facilities Fire Extinguishers and demonstrate competence In their use.The FE can verbalize adios to be made in the event of an emergency,is.evacuation of persons to a safe Nation. 10,The FE can explain how long tank systenwelated testing records and other documents should be kept by the facility (m&dmum three years in the binder or records repository,five years on ske,for the IFetirm of the tanks offsite). FacIlYy Employee Acknowledgement The Designated Operator for my facility,identified below,has reviewed with me the expectations noted above cont emkV my roles and responsibilities in keeping my factftys underground storage tank(UST)system In compliance with California's UST regulations as well as any local requirements of the Certified Unified Program Agency(CUPA)enforcing these regulations at my facility. I understand and accept the duties and rethat I am expected to perform with regard to my fadlity's Monitoring Pian and Release Response Plan.These Include implementation of facility best management practices, response to monitoring system alarms, response to spills at the fueling islands or overfills at the tank pad,contacting Identified emergency contacts in the event of a spill or release of product and the proper documentation of these activities. I have asked any questions i may have had concerning these expectations until I was satisfied I understood then.I understand that I am responsible In whole or in part for maintaining the required UST compliance documents for my station.I will ensure that these records will be kept in accordance with Provide#��jjme 6y CUPA having ju station Facility Employee Name(PFE SVatWe and Date Trained by. Lance York 5296385-UC August 12, 2016 Facility Do Name Ignaturs, International Code Council(ICC)Certification# "nallo FE refresher trainN and Expiration Date