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7VIRONMENTAL HEALTH DEPARTME <br /> SAN JOAQUIN COUNTY 19 <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: 20-MV)V) Date: 9111111 <br /> Title: <br /> Facility Address: -1401 W, N/I14 Ulm P PR#: IV <br /> C0-# 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 /> Underground Storage Tank <br /> Monitoring and Response Plans <br /> EJ 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 Jk�ll�Cn tale ' Cpl ;1 ; { <br /> Account Number <br /> Monitoring Certification(go over last MC) �� �✓'1 <br /> Due ery 12 months <br /> Spill Buckets <br /> Sensors <br /> Leak Detectors <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 i f 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 l� <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 />