Fuel-Form

Season Review Acknowledgement Form

This is a requirement for using the fuel pumps at the PYC and must be completed every year.  Fill out the following fields below.  Optionally you can download the form and bring it into the PYC office.


Name *
Name
Phone
Phone
Phone number (optional)
Question #1 *
What does SPCC stand for?
Question #2 *
In the event of a REPORTABLE spill, who does the spill discoverer internally call FIRST?
Question #3 *
What does the acronym MSDS stand for?
Question #4 *
The Spill Discoverer Should (check all that apply):
Question #5 *
Is the following statement True or False? -> "PYC personnel/members with responsibilities for compliance with the requirements of the PYC SPCC Plan will participate in periodic training that teaches personnel/members to perform their duties in a way to prevent the discharge of harmful quantities of oil or hazardous substances. This training will include familiarization with this Plan, emergency response procedures, equipment, systems, and MSDS for the products stored onsite."
Question #6 *
The Spill Discoverer/Responder’s Should (check all that apply)
I Certify That: *
I hereby acknowledge receipt of the PYC SPCC Training Manual Version I adopted on June 10, 2004. I understand that each boating season I am required to review the manual as a requirement in order for me to have authorization to use the PYC fuel pumps. I have reviewed the manual and evidence my agreement to abide by the PYC SPCC Plan as outlined in the PYC SPCC Training Manual.
Date: *
Date: