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ENVIRONMENTAL 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: (�L S Date: /0 <br /> Title: 6 a <br /> Facility Address: '/p� !AI t- t GVI ann.><C[Gi PR#: 07,314, <br /> compnw Task Comments <br /> ®' Under ound Storage Tanks-Facility Form t,t-s� <br /> ❑ Underground Storage Tanks-Tank FormsEl a u <br /> Financial Responsibility/Letter from Chief t <br /> Financial Officer. Due every 12 months {` <br /> ❑ Underground Storage Tank tt <br /> Monitoring and Response Plans " <br /> Report#5021 Completed <br /> ❑ Designated UST Operator Statement n n <br /> Best Management Practices(BMP's)for Retail <br /> LI Gasoline Outlets " t' <br /> ❑ Board of Equalization UST Storage Fee <br /> Account Number <br /> Monitoring Certification(go over last MC) <br /> Due ery 12 months <br /> O' Spill Buckets U t( <br /> p' Sensors t ti <br /> R� Leak Detectors t I 11 <br /> 0 Line Test Requirements(if needed or not <br /> for pressurized piping) 0)A <br /> Sensor/Leak Detector failures can have <br /> emergency replacement with EHD permit ; <br /> obtained within 2 S of replacement ` <br /> 0 All other work must have EHD permit <br /> prior to work being performed <br /> L� 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 r G ltiw <br /> Cdr California EPA ID number �Jro✓tc�z <br /> al/ Hazardous waste generator <br /> 01' Hazardous Materials Management Plan <br /> ❑ Free UST and CUPA Classes Handout Provided <br /> Consultation by: X4/1 , i\10flYN <br />