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*VIRONMENTAL HEALTH DEPARTM* <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 Representative: (mfpo-) Date: I <br /> (H 14 <br /> Title: <br /> Facility Address: ll) . 8 ✓� C6-_ SR#: <br /> %420 e Complaw Task Comments <br /> ❑ <br /> Underground Storage Tanks-Fac ili Form Enter into CERS <br /> ❑ Underground Storage Tanks-Tank Forms Enter into CERS <br /> 0 Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months Upload document into CERS <br /> LI Monitoring <br /> Storage Tank <br /> Monitorin and Response Plans Enter into CERS <br /> ❑ Report#5021 Completed <br /> ❑ Designated UST Operator Statement Upload document into CERS <br /> L] Gasoline <br /> Management Practices(BMP's)for Retail <br /> Gasoline Outlets <br /> ❑ Board of Equalization UST Storage Fee <br /> Account Number Enter into CERS <br /> LI Due <br /> Certification(go over last MC) <br /> Due eve 12 months <br /> ❑ Spill Buckets <br /> ❑ Sensors/Leak Detectors <br /> LI for <br /> Test Requirements(if needed or not <br /> for ressurized piping) <br /> Sensor/Leak Detector failures can have <br /> ❑ 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 /> 0 Secondary Containment Requirements <br /> Go over last date- Due every 36 months <br /> ❑ California EPA ID number Enter into CERS <br /> ❑ Hazardous waste generator Permit <br /> ❑ Hazardous Materials Management Plan Enter into CERS <br /> ❑ Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />