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VIRONMENTAL HEALTH DEPARTME <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: <br />Title: mr, 0&5 -- <br />Facility Address: 4r -,2,-4-,y G t, <br />`, �0 q-,5, <br />Date: ! 1 <br />amlwffl'`'`ir <br />Completed Task Comments <br />Underground Storage Tanks -Facility Form <br />Underground Storage Tanks -Tank Forms <br />Financial Responsibility/Letter from Chief <br />Financial Officer. Due every 12 months <br />L ( "Jell C� <br />Underground Storage Tank <br />Monitoring and Res onse Plans <br />Report #5021 Completed <br />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 />® <br />Line Test Requirements (if needed or not <br />for pressurized piping) <br />Sensor/Leak Detector failures can have <br />emergency replacement with EHD permit <br />obtained within Z h 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 <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 />it <br />