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Z <br />._N*VIRONMENTAL 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 //' <br />Representative: Cn U 1'M P e % s% 1 J (%fy jA Sle a Date: , <br />11 <br />Title: nio" i <br />Facility Address: 2I A , )A 1 (� 01�`=�`I <br />r— <br />cumpin Task Comments <br />Underground Storage Tanks -Facility Form <br />Underground Storage Tanks -Tank Forms <br />/V0 rti ' <br />�d <br />Financial Responsibility/Letter from Chief <br />Financial Officer. Due every 12 months <br />Underground Storage Tank�c <br />Monitoringand Response Plans <br />C C� <br />('h <br />Report #5021 Completed <br />❑ <br />Designated UST Operator Statement <br />O bZ <br />Best Management Practices (BMP's) for Retail <br />Gasoline Outlets%(! <br />❑ <br />Board of Equalization UST Storage Fee <br />Account Number <br />Monitori ertification (go over last MC) <br />Due ve 12 months <br />Spill Buckets <br />, <br />6Y <br />Sensors <br />S <br />LIK <br />Leak Detectors <br />Line Test Requirements (if needed or not <br />for pressurized piping) <br />Sensor/Leak Detector failures can have <br />emergency replacement with EHD permit <br />obtained within of replacement <br />All other work must have EHD permit <br />prior to work being performed <br />UST owner is responsible to see that EHD <br />permits are properly obtained <br />Secondary Containment Requirements <br />Go over last date - Due every 36 months <br />r <br />NQ�2tr d . r2ce�(ZOCT sgq g <br />(k !;rlb �T W1 �ZL12 <br />California EPA ID number <br />/ <br />�% J (( C4, "[ 'flim <br />Hazardous waste generator <br />-rCLA C cv� �(-1( <br />9' <br />Hazardous Materials Management Plan <br />w C <br />Free UST and CUPA Classes Handout Provided <br />Consultation by: <br />S <br />qC <br />WN <br />'�3 <br />I <br />