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IRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 1868 E.Hazelton Ave. <br /> Stockton,Califomia 95205 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility <br /> Representative: Date: <br /> Title: <br /> Facility Address: 14 y4 . W LA7� .-PCP q)'33y SR#: O b z3 g 6 <br /> Completed Task Comments <br /> JA Underground Storage Tanks-Facility Form Enter into CERS <br /> Under ound Storage Tanks-Tank Forms Enter into CERS <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months Upload document into CERS YC Vi� <br /> XUnderground Storage Tank W <br /> � C ( Kh & S <br /> Monitoring and Response Plans Enter into CERS <br /> Report#5021 Completed <br /> Designated UST Operator Statement Upload document into CERS VVV IGCs l5 <br /> Best Management Practices(BMP's)for Retail <br /> J� Gasoline Outlets <br /> Board of Equalization UST Storage Fee <br /> Account Number Enter into CERS — "[ <br /> Monitoring Certification(go over last MC) <br /> Due eve 12 months � � � �� C'�1 s <br /> Spill Buckets <br /> J� Sensors/Leak Detectors <br /> Line Test Requirements(if needed or not <br /> for pressurized piping) <br /> Sensor/Leak Detector failures can have <br /> J� 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 <br /> j� Go over last date- Due every 36 months <br /> California EPA ID number .G ,V 0V i C� •Enter into CERS �.t�� ���-5 <br /> Hazardous waste generator Permit <br /> Hazardous Materials Management Plan Enter into CERS <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: Oe in a Yl �i 4 <br />