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UNDERGROUND STORAGE TANK <br /> AU f t Y EMPLOYER KNOW& GETRANtaAT (page i vyp <br /> C�Ea�ii.eas Ra,=_! (�L raWs r=Wf f f,t�ri�a �rwF ���•nri 'Wv±n�ss :-s} <br /> 10181391 to I(ft? <br /> Bu-sins 'Sit"ti s"=,c1drr.ss cwy <br /> VP Goa <br /> ST JOSEPHS HOSPITAL _ _ _ _ ,STOCKTON 95204 <br /> E UND STORAGE TANK OPERATOR INFOPHVIATIONi <br /> Horne of DeFs cjnaled UST=T t7pr:Qu MAN,tie TrAQ�ng(0inf t s SFtmvn or tPzc ICC <br /> Dave W nMer <br /> A tli"j Adtims516 nd Yi; ne <br /> .StreetGait CA - _ ._.._----_.._. - ---- - - _ _ _..___-__-J_ (209) 74 - <br /> y <br /> I 88830 9=UC 2//12022 <br /> M. FACILITY EMPLOYEE INFORMAT ION <br /> iradsvicival assw1ing tale dUfleS facifity employee before October 13,2018 €nuBt be trained withtn 30 days of pe=rnWng I <br /> aciiityr ornpto yce,dufles.Indivit LMIS assu €air?g Ow di.a ks cif the facility employe-a on and after Oflwbor 13,2018 musk be trained <br /> before performing fpciiity empioyce duties. <br /> Check this'box if Ihs?'..3f the indi r#rl.°uaff)grith7t:Ci°1.;ap-pend"ed to thi'i op-117, 7"he'—{3p<`t'iCi`ed fisi.f 6 Y1dY?ffMe'M mSt comas <br /> SPF or fhe infoavaaon fin this:�cctic n. <br /> Date of Assufliinq <br /> rani f Individual(s)Trained gEBa l�3i Yc lTztE?i ct�' I Rc�pon.MS€Nilty as a I <br /> Facility Eniplo�", <br /> [q}tel <br /> �y l <br /> F <br /> 0„ 70 P <br /> Atm <br /> (6�f.,a ! (2,p LLS -- - - ------- I Jo 2-1 <br /> 1X7/2 <br /> E <br /> I <br /> 10 /2-7 f�1 1 l z-7/z[ <br /> €11. CERTIFICATiONBY DESIGNATED UST OPERATOR CONDUCTING' THIS TRAINING <br /> Tho f cr ii'q eniployr-,es Usted �iboae have coniple e , tk)e rerstAred training firs accordaa?ca mOh Ctilii€cr= Go& ref Regulat nns, ; <br /> i <br /> Title 23, Division 3, Chaptew 10 Sectio `1; ,;°�c)and a ,the information provided herein is accurate. <br /> Tr nr;f? sinew d EJST C}fs,raitar Sigriritsr":. _ — Mite of <br /> i.ERS=Ca[,4on iib ritf?N11!'?Eitll_.i pepu ti'j syslean7 ID icc_.!r l!�-Tn i?o al('QV:;1..13.if1 �'i,UST Undegjit]ul u to!acjz?Taf ik, <br />