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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUINCOUNTY1N3!A11RHd3a <br /> 600 E.Main Street lltw3H WiN3VVN0H1AN3 <br /> Stockton,California 95202 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist"" I o inr <br /> Facility X11 l N Oo�UL�{v� <br /> Representative: lEtimP� ( Date: <br /> Title: M P`VVje,-,.,.- <br /> Facility Address: �.�O��JI lA`� �V Y. I P lay t-oa, PR# casj Lf �;q <br /> Paw Task Comments <br /> ❑ Underground Stora Le Tanks-Facility Form &- V UL) <br /> ❑ Underground StoLaE Tanks-Tank Forms <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months <br /> Underground Storage Tank <br /> Monitoring and Response Plans <br /> Report#5021 Completed t/ <br /> Designated UST Operator Statement -i cc- <br /> Best <br /> f eBest Management Practices(BMP's)for Retail <br /> Gasoline Outlets rdvl <br /> Board of Equalization UST Storage Fee <br /> Account Number !S rl ClLc Q , <br /> Monitoring Certification(go over last MC) <br /> Due every 12 months ( Q �� {A I Q amp. <br /> B' Spill Buckets <br /> 2f Sensors <br /> wa R <br /> Leak Detectors E i' y P <br /> Line Test Requirements(if needed or not <br /> for pressurized piping) JUL <br /> Sensor/Leak Detector failures can have <br /> 4- emergency replacement with EBD permit ENVIRONMENTAL HEALTH <br /> obtained within of replacement DFPARTAITNT <br /> `6 All other work must have EHD permit <br /> prior to work being performed <br /> d UST owner is responsible to see that EBD <br /> permits are properly obtained <br /> Secondary Containment Requirements <br /> Go over last date- Due every 36 months 110 - g-0 q <br /> fd California EPA ID number Q m ood eA , nud <br /> ,0 Hazardous waste generator UI <br /> Hazardous Materials Management Plan' e <br /> CJL- <br /> Free UST and CUPA Classes Handooutt�Provided <br /> Consultation by: 1 l K {n <br />