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P%IVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 304 East Weber Avenue,Third Floor <br /> Stockton,California 95202 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility J <br /> Representative: 640aw � rVialil Date: ► a <br /> Title: 0 lol t J r�) <br /> Facility Address: 1112 PJ' 41 %00(t 51:7� PR#: VfZ4 51L o <br /> CO./d Task Comments <br /> 15 Under ound Storage Tanks-Facility Form <br /> Underground Storage Tanks-Tank Forms <br /> Financial Responsibility/Letter from Chief ownt✓ Sw"t (nStvahc t GNI { 5 j <br /> Financial Officer. Due every 12 months Vlt <br /> Underground Storage Tank <br /> Monitoring and Response Plans <br /> Report#5021 Completed <br /> Designated UST Operator Statement <br /> Best Management Practices(BMP's) for Retail <br /> Gasoline Outlets <br /> 4— Board of Equalization UST Storage Fee <br /> Account Number <br /> Monitoring Certification(go over last MC) <br /> Dupe very 12 months <br /> Spill Buckets <br /> Sensors <br /> Leak Detectors <br /> Line Test Requirements(if needed or not Ip( <br /> for pressurized piping) tt <br /> Sensor/Leak Detector failures can have <br /> emergency replacement with EHD permit <br /> obtained within eplacement <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 /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />