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Rev.OVG3lM I UST Facility ID �PERATORS PFJ 1017 of sovree.r uwrwMu Training Acknowledgement Form "Facili Em to ee" Hazardous Materials Trainin EmployeeFacility . Date gV\2, VY�, Pilot Flying J - #1017 345 Roth Rd. Lathrop, CA 95330 l EmployeeFacility FE Initials if Reviewed Compliance Expectabons DO hm Reviewed with FE 1. The FE can locate and describe tank and piping systems as well as monitoring equipment.The FE can explain the Daily 1� Monitoring System Check and Alarm/Response requirements and is competent in completing these forms.The FE is �j aware of the significance of various Tank Monitoring Alarms and aware of who to contact in that event. 2. The FE can define which materials at the facility are hazardous and what makes them hazardous.The FE can describe Nwhere and how these materials are stored. 3. The FE can identify and describe how hazardous materials are to be handled,stored and disposed of.The FE can explain the compatibility issues regarding the storage of hazardous waste.The FE can describe basic regulations regarding the storage of Hazardous Wastes,such as labeling(including'Start Date')and completion of a Weekly Inspection Checklist. 4. The FE can describe the purpose of the Safety Data Sheets(SDS)and where this information is available.The FE can 4� describe basic information available in the SDS and their purpose in the event of emergency.The FE can initiate basic First Aid in the event of hazardous exposure or injury to any persons onsite. 5. The FE can explain the purpose of the facility's Release Response Plan and can demonstrate knowledge about spilVleak response("worst case discharge"and"most likely discharge")including completing the facility's Spill Log.The FE can `�J l differentiate between'Recordable'spills and'Reportable'spills and can describe the requirements of each 6. 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 the spill kit as well as Personal Protective Equipment(PPE)required. 7. The FE can locate and identify other hazardous materials onsite such as Carbon Dioxide(for beverage fountain)and co various automotive products that are available for sale in the store.The FE is also aware of transient hazardous materials that might be passing through the facility in or on a customers'vehicle. S. The FE is aware of"Universal Waste"requirements and what types of universal wastes might be accumulated from the sites operations.The FE is aware of storage and labeling regulations regarding"Universal Wastes" �T 9 The FF can indicate the location of emergency shut off switches 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 actions to be made in the event of an emergency,including the containment of hazardous material, isolation of the spill area and evacuation of persons to a safe location.The FE can locate and utilize the sites'Contact List. 10. The FE is aware of the Spill Prevention,Control and Containment Plan(SPCC)and Storm Water Run-off Regulations.The FE is aware of best management practices to reduce and eliminate the release of pollutants during rainy periods. Facility Employee Acknowledgement: The Designated Operator for my facility, identified below, has reviewed with me the expectations noted above concerning my roles and responsibilities in keeping my facility's 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 responsibilities that I am expected to perform with regard to my facility's Monitoring Plan 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 �derstopd them. I understand that I am responsible in whole or in part for maintaining the required UST compliance documents for my ation. l4ill ensure that these records will be keptaccordance it instructions provided to me by the CUPA having jurisdiction over s6tion,� / Facility Employee Name(Please Prin FE Signature and Date Trained by: Lance York 5296385-UC /August 1, 2022 Facility DO Name Si ature, International Code Council(ICC)Certification# nfirmati o refresher training and Expiration Date