Laserfiche WebLink
UST Response Plan — Instructions <br />Complete one UST Response Plan for each UST facility. This form must be submitted with your initial UST Operating Permit <br />Application and within 30 days of changes in the information it contains. It supplements the Emergency Response Plans and <br />Procedures in the facility's Hazardous Materials Business Plan. (Note: Numbering of these instructions follows the Unified Program <br />Consolidated Form data element numbers on the form.) <br />ROI . TYPE OF ACTION — Check the appropriate box to indicate why this plan is being submitted. <br />FACILITY 1D NUMBER — This space is for agency use only. <br />R02. FACILITY NAME — Enter the complete Facility Name. <br />R03. FACILITY SITE ADDRESS — Enter the street address where the facility is located, including building number, if applicable. <br />Post office box numbers are not acceptable. This information must provide a means to locate the facility geographically. <br />R04. CITY — Enter the city or unincorporated area in which the facility is located. <br />RIO. EQUIPMENT — If you have spill control or clean-up equipment kept off-site, list that equipment in sections RIO through R15. <br />If no equipment is kept off-site, leave this section blank. <br />R20. LOCATION — If you have spill control or clean-up equipment kept off-site, list the equipment location(s) sections R20 through <br />R25. If no equipment is kept off-site, leave this section blank. <br />R30. AVAILABILITY — If you have spill control or clean-up equipment kept off-site, list the equipment availability in sections R30 <br />through R35. If no equipment is kept off-site, leave this section blank. <br />R40. NAME — At least one person responsible for authorizing any work necessary under this UST Response Plan must be identified. <br />Use sections R40 through R43 to list the name(s) of the responsible person(s). <br />R50. TITLE — At least one person responsible for authorizing any work necessary under this UST Response Plan must be identified. <br />Use sections R50 through R53 to list the job title(s) of the responsible person(s). <br />R60. INDIRECT HAZARD DETERMINATION —This section applies only when the presence of the hazardous substance can not be <br />determined directly by the monitoring method used (e.g., hydrostatic monitoring of a tank annular space, where liquid level <br />measurements are used as the basis for leak determination). Briefly describe the steps that will be taken to determine the <br />presence or absence of hazardous substance in the secondary containment if monitoring indicates a possible unauthorized <br />release. <br />OWNER/OPERATOR SIGNATURE — The owner/operator shall sign in the space provided. This signature certifies that the <br />signer believes that all information submitted is true, accurate, and complete. <br />R70. DATE — Enter the date the plan was signed. <br />R71. OWNER/OPERATOR NAME — Print or type the name of the person signing the plan. <br />R72. OWNER/OPERATOR TITLE — Enter the title of the person signing the plan. <br />SJCEHD-e (06/03) - 2/3 06/25/03 <br />