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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: S^1 Date: $ 0 g <br />Title: 6 LAN\J-� <br />Facility Address: tjbiz 174 /iyer , fi lfti-F-GA <br />PR#: O 2,3 t 054 - <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 />Underground Storage Tank <br />Monitoring and Response Plans <br />❑ <br />Report #5021 Completed <br />diyu_ <br />Crt' <br />Designated UST Operator Statement <br />Best Management Practices (BMP's) for Retail <br />Gasoline Outlets <br />Ld <br />Board of Equalization UST Storage Fee <br />Account Number <br />❑ <br />Monitoring Certification (go over last MC) <br />Due every 12 months <br />❑ <br />Spill Buckets <br />❑ <br />Sensors <br />❑ <br />Leak Detectors <br />❑ <br />Line Test Requirements (if needed or not <br />for pressurized piping) <br />Sensor/Leak Detector failures can have <br />❑ <br />emergency replacement with EHD permit <br />obtained within of replacement <br />❑ <br />All other work must have EHD permit <br />prior to work being performed <br />❑ <br />UST owner is responsible to see that EHD <br />permits are properly obtained <br />Secondary Containment Requirements <br />p J <br />Go over last date - Due every 36 months <br />California EPA ID number <br />CJ' <br />Hazardous waste generator <br />Hazardous Materials Management Plan <br />d <br />Free UST and CUPA Classes Handout Provided <br />Consultation by: M • PM D vA <br />