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1NVIRONMENTAL HEALTH DEPARTMF` <br /> SAN JOAQUIN COUNTY <br /> 1868 E.Hazelton Ave. <br /> Stockton,California 95205 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility <br /> Representative: V,-V L..Pn P Su 04A A Date: o 16 I I <br /> Title: t <br /> Facility Address: ` Cke SR#: �1!✓ �j � <br /> co pleted Task Comments <br /> Underground Storage Tanks-Facility Form Enter into CERS <br /> Underground Storage Tanks-Tank Forms Enter into CERS <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months Upload document into CERS <br /> Underground Storage Tank <br /> <11 Monitoring and Response Plans Enter into CERS <br /> Report#5021 Completed <br /> Designated UST Operator Statement Upload document into CERS <br /> Best Management Practices(BMP's)for Retail <br /> Gasoline Outlets <br /> Board of Equalization UST Storage Fee <br /> Account Number Enter into CERS <br /> Monitoring Certification(go over last MC) <br /> Due every 12 months SCJ <br /> Spill Buckets <br /> Sensors/Leak Detectors <br /> �y Line Test Requirements(if needed or not <br /> 7" for pressurized pi in <br /> Sensor/Leak Detector failures can have <br /> emergency replacement with EHD permit <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 Submit UST Owner/Operator written agreement(if <br /> permits are properly obtained. applicable). Can upload document to CERS <br /> Required to create a CERS account at <br /> cers.calepa.ca.gov Provide Lead User Authorization Form <br /> Secondary Containment Requirements 01' a ,, <br /> Go over last date- Due every 36 months <br /> California EPA ID number Enter into CERS <br /> Hazardous waste generator Permit } W <br /> Hazardous Materials Management Plan Enter into CERS <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: �[4U Ck Ct t 1 -� <br />