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4 <br />""NVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />600 E. Main Street <br />Stockton, California 95202 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />UST Consultation Checklist <br />Facility �(VA <br />Representative: rorus <br />Title: r <br />Fac>, ity Address: a� <br />Date: L 2j <br />PR#: 13 h <br />Completed Task Comments <br />Sd <br />Underground Storage Tanks -Facility Form <br />Underground Storage Tanks -Tank Forms <br />Financial Responsibility/Letter from Chief <br />n/' S 4 Q, <br />Financial Officer. Due every 12 months <br />Underground Storage Tank <br />Monitoring and Response Plans <br />Report #5021 Completed <br />© <br />Designated UST Operator Statement%- <br />%" <br />Best Management Practices (B 's) for Retail <br />Gasoline Outlets <br />Board of Equalization UST Sora e Fee <br />oilnn <br />�e <br />Account Number � � 3 <br />OA 7� <br />❑ <br />Monitoring Certification (go over last MC) <br />Due every 12 months <br />❑ <br />Spill Buckets <br />❑ <br />Sensors <br />❑ <br />Leak Detectors <br />❑ <br />Line Test Requirements (if needed or not <br />for pressurized piping) <br />Sensor/Leak Detector failures can have <br />❑ <br />emergency replacement with EHD permit <br />obtained within of replacement <br />❑ <br />All other work must have EHD permit <br />prior to work being performed <br />❑ <br />UST owner is responsible to see that EHD <br />permits are properly obtained <br />D! <br />Secondary Containment Requirements lvfye <br />`v , <br />Go over last date - Due every 36 months <br />California EPA ID number <br />Hazardous waste generator <br />Hazardous Materials Management Plan ►� <br />(5 3 6200 <br />Free UST and CUPA Classes Handout Provided <br />Consultation by: <br />