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`,,JST Response Plan—Instructions <br /> Complete one UST Response Plan for each UST facility. This form must be submitted with your initial UST Operating Permit <br /> Application and within 30 days of changes in the information it contains. It supplements the Emergency Response Plans and <br /> Procedures in the facility's Hazardous Materials Business Plan. (Note: Numbering of these instructions follows the Unified Program <br /> Consolidated Form data element numbers on the form.) <br /> R01. TYPE OF ACTION—Check the appropriate box to indicate why this plan is being submitted. <br /> FACILITY ID NUMBER—This space is for agency use only. <br /> R02. FACILITY NAME—Enter the complete Facility Name. <br /> R03. FACILITY SITE ADDRESS —Enter the street address where the facility is located, including building number, if applicable. <br /> Post office box numbers are not acceptable. This information must provide a means to locate the facility geographically. <br /> R04. CITY—Enter the city or unincorporated area in which the facility is located. <br /> RIO. EQUIPMENT—If you have spill control or clean-up equipment kept off-site, list that equipment in sections RIO through R15. <br /> If no equipment is kept off-site,leave this section blank. <br /> R20. LOCATION—If you have spill control or clean-up equipment kept off-site, list the equipment location(s) sections R20 through <br /> R25. If no equipment is kept off-site, leave this section blank. <br /> R30. AVAILABILITY—If you have spill control or clean-up equipment kept off-site, list the equipment availability in sections R30 <br /> through R35. If no equipment is,kept off-site, leave this section blank. <br /> R40. NAME—At least one person responsible for authorizing any work necessary under this UST Response Plan must be identified. <br /> Use sections R40 through R43 to list the name(s)of the responsible person(s). <br /> R50. TITLE—At least one person responsible for authorizing any work necessary under this UST Response Plan must be identified. <br /> Use sections R50 through R53 to list the job title(s)of the responsible person(s). <br /> R60. INDIRECT HAZARD DETERMINATION—This section applies only when the presence of the hazardous substance cannot be <br /> detemuned directly by the monitoring method used (e.g., hydrostatic monitoring of a tank annular space, where liquid level <br /> measurements are used as the basis for leak determination). Briefly describe the steps that will be taken to determine the <br /> presence or absence of hazardous substance in the secondary containment if monitoring indicates a possible unauthorized <br /> release. <br /> OWNER/OPERATOR SIGNATURE — Thp owner/operator shall sign in the space provided. This signature certifies that the <br /> signer believes that all information submitted is true, accurate,and complete. <br /> R70. DATE—Enter the date the plan was signed. <br /> R71. OWNER/OPERATOR NAME—Print or type the name of the person signing the plan. <br /> R72. OWNER/OPERATOR TITLE—Enter the title of theperson signing the plan. <br /> SJCEHD-e(06/03)-2/3 - 06/25/03 <br />