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ENVIRONMENTAL HEALTH DEPARTMENT <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 <br /> Representative: J Date: l a 16 O l <br /> Title: � J•/ Go[ll/�.tC^AAP/_ <br /> Facility Address: f 13,7 l2ca— , e2aja&CA PR#: <br /> Completed Task Comments <br /> Ld Underground Storage Tanks-Facility Form <br /> Qe—Underground Storage Tanks-Tank Forms <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months <br /> dUnderground Storage Tank <br /> Monitoring and Response Plans <br /> D Report#5021 Completed <br /> LiK Designated UST Operator Statement RQ 1� � Qi►iY� <br /> Best Management Practices(BMP's) for Retail ' I ��P d� <br /> Gasoline Outlets �,et+ G�^t <br /> Board of Equalization UST Storage Fee <br /> Account Number 5f- '`1 IL.m eo - &-L3(6(_3 c D o 94- (cl <br /> Monitoring Certification(go over last MC) <br /> Due every 12 months <br /> Spill Buckets <br /> al' Sensors <br /> t <br /> 2' Leak Detectors p�(�p-'c <br /> la' Line Test Requirements(if needed or not t � <br /> for pressurized piping) <br /> Sensor/Leak Detector failures can have c7vl`! ez ''' <br /> 0/ emergency replacement with EHD permit ►" A"'^/l °�" /�� � -vv-� <br /> obtained within-2,1 Iftm of replacement A ' <br /> All other work must have EHD permit <br /> prior to work being performed <br /> a/ UST owner is responsible to see that EHD <br /> permits are properly obtained <br /> Secondary Containment Requirements �'4 VPf <br /> Go over last date- Due every 36 months f <br /> U/ California EPA ID number CA-1- V,�9 D3 q­& <br /> f� Hazardous waste generator <br /> W/ Hazardous Materials Management Plan damA147 OES <br /> f( Free UST and CUPA Classes Handout Provided <br /> Consultation by: M • /✓/3t(yr� <br />