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""INVIRONMENTAL HEALTH DEPARTMEN-e Z APt Sc kS4 <br /> SAN JOAQUIN COUNTY l� <br /> 1868 E.Hazelton Ave. �l �f c) <br /> Stockton,California 95205 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility <br /> Representative: t)n�'�Q OQer— C7&--S �/ ate: <br /> J---- <br /> Title: d w A-Q'r <br /> Facility Address: L�- M k ��� d �c+cSy1 SR#: 5Ieod F0 <br /> Comp ea Task Comments <br /> Underground Storage Tanks-Facility Form Enter into CERS n s K b { <br /> ❑ Underground Storage Tanks-Tank Forms Enter into CERS <br /> ❑ Financial Responsibility/Letter from Chief I <br /> r <br /> Financial Officer. Due every 12 months Upload document into CERS Krr� c <br /> ❑ Underground Storage Tank <br /> Monitoring and Response Plans Enter into CERS <br /> Report#5021 Completed b <br /> L7 Designated UST Operator Statement Upload document into CERS rm fu o w <br /> Best Management Practices(BMP's)for Retail <br /> Gasoline Outlets <br /> Lj Board of Equalization UST Storage Fee A j.. iM �2 /zv IS <br /> Account Number Enter into CERS (� <br /> Monitoring Certification(go over last MC) <br /> Due gvery 12 months �V'L t e-L J u r,-( ZU <br /> 19/1 Spill Buckets <br /> Sensors/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 /> obtame within 2� A,),►cif replacement <br /> All 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 /> L) Required to create a CERS account at <br /> cers.calepa.ca.gov Provide Lead User Authorization Form <br /> .�a <br /> Secondary Containment Requirements - <br /> Go over last date- Due every 36 months �gC� 04 <br /> Kirt <br /> California EPA ID number Enter into CERS � fD Ian* <br /> Hazardous waste generator Permit <br /> Hazardous Materials Management Plan Enter into CERS <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: P <br />