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F RONMENTAL HEALTH DEPARTMENT <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 I <br /> Representative: V �L �.5L. \ -c�s� Date: 12 I 1`�C� <br /> Title: ©uW►�:� <br /> Facility Address: LA 2-0 SR#: <br /> Completed Task Comments <br /> Underground Storage Tanks-Facility Form Enter into CERS QovlA <br /> Underground Storage Tanks-Tank Forms Enter into CERS <br /> Financial Responsibility/Letter from Chief n ,� <br /> Financial Officer. Due eve 12 months Upload document into CERS N-t <br /> Underground Storage Tank <br /> Monitoring and Response Plans Enter into CERS <br /> Report#5021 Completed �� 4b l 1 <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 Nz � <br /> Account Number Enter into CERS <br /> Monitoring Certification(go over last MC) L4 I 1 <br /> Due every 12 months 1 <br /> 14 Spill Buckets <br /> Sensors/Leak Detectors <br /> Line Test Requirements(if needed or not <br /> for ressurized piping) <br /> Sensor/Leak Detector failures can have <br /> 1$( emergency replacement with EHD permit <br /> obtained within i b g 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 � R. g111 <br /> cers.calepa.ca.gov Provide Lead User Authorization Form <br /> 93 <br /> Secondary Containment Requirements 120 1 t <br /> Go over last date- Due every 36 months l <br /> California EPA ID number Enter into CERS N �"�' <br /> J Hazardous waste generator Permit <br /> y1< Hazardous Materials Management Plan Enter into CERS N UZ'C" <br /> Free UST and CUPA Classes Handout Provided V1&C9- 0 d1 �(24 <br /> Consultation by: 2--U VNI 0-- vo a�c��� <br />