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Uft <br />FACILI UNDI:RGROUNp STO <br />�MP�pyE TRA�N�NG SRT ANK <br />as Na <br />1=8c,1I. FACILI jFiCATE (Page 1 of 9 j <br />d) me or D13A.Doing Business As <br />INFG <br />PMA7i0N <br />-IEU�?O�u <br />ll. DE51GNA7Ep <br />Netr� of Designated 08T Operator providing UNDERGROU <br />ND STORAGE WANK QP O <br />MaBing Address raining (pent es show ERATOR�,U;: <br />O <br />n on the ICC ce RMATION <br />�ttcetlon.) <br />�L�C � .,-... <br />Individuals as&umEn lli. " """' txplraticn Date <br />FACILITY �MpLOYl:I: INFORM <br />tat !I tl the duties of the facility ATION <br />Wore emplayoa dutlos. Individuals assumip employoe before October 13, 2018 <br />performing facility <br />emGloYee dullos, 9 the du�fos of the [acili employee must be trained <br />ty em toe d after October 1338 days of <br />Check this b eon an performing <br />ox if a list of the !ndlvJtiva! ' 2018 must be trained <br />all of the Information (s) trained is a <br />In this sectlan. 'PQnded fo this Corm. <br />the appended list ata <br />minimum, musf contain <br />Nape of Individuals) TraEned <br />Initial Training pat I Date of As Inm <br />ResponstbIIIty as a <br />VE <br />L5 I2o <br />IV. CERTIFICATION BY DESIGNATED U5T OPE <br />Th facility employees listed above have completed the required tralning In C� daDn a with CaElfamla C <br />Tltt 23, Division 3, Chapter 16, 5 RAif�lING <br />r octlo 2715tc) II tho Information <br />Tra Ing faesignal UST erater Sign e l Provided herein Is accurate, °dg of Regulations, <br />CERS Em� Regis gym, to , IdEntiF !C = tnternalior,al Code Cacc1 lssr - tJ vt':1' I Y <br />c <br />4II , 9rarr1 S Drage Tank <br />