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1 <br /> .NVIRONMENTAL HEALTH DEPARTM <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 I / <br /> Representative: �Q Y'M I '� 5f/I /� Date: <br /> Title: W ��I/' �r-fS(a4.0l� I r <br /> Facility Address: 1 3 5; . 1A-) 0 S Cf-y*x PR#: <br /> Comple a Task Comments <br /> ►4, Underground Storage Tanks -Facility Form �C k r#t ' �- <br /> Underground Storage Tanks-Tank Forms <br /> Financial Responsibility/Letter from Chief A' <br /> Financial Officer. Due every 12 months NO yr Xgeart <br /> Underground Storage Tank <br /> Monitoring and Response Plans <br /> Report 45021 Completed <br /> -�k Designated UST Operator Statement <br /> Best Management Practices(BMP's)for Retail <br /> Gasoline Outlets <br /> Board of Equalization UST Storage Fee <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 /> timer enc:replace�me`t with EHD permit PdCS �o �n cl t� /10Z <br /> obtarn�thinf 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 /� A , n Q C I JD[A-L ;n <br /> Go over last date- Due every 36 months (HJT v , /"(a y M^ <br /> California EPA ID number <br /> Hazardous waste generator <br /> Hazardous Materials Management Plan "e-Z W Kkr c r' P 1.-3Z M <br /> o r ✓1n <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />