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�...VIRONMENTAL HEALTH DEPARTMEN1 <br /> SAN JOAQUIN COUNTY <br /> 1868 E.Hazelton Ave. <br /> Stockton,Califomia 95205 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility. <br /> Representative: Date: S Z(Q (S <br /> Title: DPR -- <br /> Facility Address: 22%%0 �Xdcv` 'SA1 _ SR#: <br /> Completed Task Comments <br /> ❑ Underground Storage Tanks-Facility Form Enter into CERS <br /> ❑ Underground Storage Tanks-Tank Forms Enter into CERS <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months Upload document into CERS <br /> Underground Storage Tank <br /> Monitoring and Response Plans Enter into CERS <br /> eport#5021 Completed , <br /> Designated UST Operator Statement <br /> Upload document into CERS ` <br /> Best Management Practices(BMP's)for Retail <br /> Gasoline Outlets <br /> Board of Equalization UST Storage Fee <br /> Account Number Enter into CERS <br /> 'Monitoring Certification(go over last MC) <br /> Dueavery 12 months <br /> [,S ill Buckets <br /> Sensors/Leak Detectors <br /> Line Test Requirements(if needed or not <br /> for pressurized piping) <br /> ensor/Leak Detector failures can have <br /> emergency replacement with EHD permit <br /> obtained within of replacement <br /> eedAll other work must have EHD permit <br /> prior to work being performed <br /> UST owner is responsible to see that EHD Submit UST Owner/Operator written agreement(if <br /> permits are properly obtained. applicable). Can upload document to CERS <br /> Required to create a CERS account at <br /> cers.calepa.ca.gov Provide Lead User Authorization Form <br /> Secondary Containment Requirements �/V5/13 --I> b I <br /> M l co <br /> Go over last date- Due every 3 6 months l( <br /> California EPA ID number Enter into CERS <br /> Hazardous waste generator Permit <br /> ❑ Hazardous Materials Management Plan Enter into CERS <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />