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' VIRONMENTAL HEALTH DEPARTMEP <br /> y SAN JOAQUIN COUNTY w <br /> 600 E.Main Street <br /> Stockton,California 95202 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility �O <br /> Representative: I /uI�QfV Date: <br /> �/Iq�G <br /> Title: _ <br /> Facility Address: PR#:Q��«2! <br /> Coma � Task Comments <br /> Under round Stora e Tanks -Facilit Form <br /> Under ound Stora e Tanks -Tank Forms <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due eve 12 months <br /> Underground Storage Tank <br /> Mom orin and Response Plans <br /> Report#5021 Completed <br /> Designated UST Operator Statement <br /> Best Management Practices(BMP's)for Retail <br /> Gasoline Outlets <br /> Board of Equalization UST Storage Fee V t tl ((/1 1 ftV IP <br /> Account Number <br /> Monitoring Certification(go over last MC) <br /> Due,every 12 months <br /> Spill Buckets <br /> ,Sensors <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 en�,t.with EHD permit <br /> II : <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 /> California EPA ID number <br /> Hazardous waste generator <br /> Hazardous Materials Management Plan <br /> tYz Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />