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�VIRONMENTAL HEALTH DEPARTMF� <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 <br /> Representative: IPA lr S�'rt�� Date: tj i 5- <br /> Title: O w vac✓ <br /> Facility Address: _LA ST '/r �,,,4e– cn-e– sca t C g S33:–SR#: 4ao j o q <br /> Completed Task Comments <br /> Underground Storage Tanks-Facility Form Enter into CERS ( WAA <br /> Underground Storage Tanks-Tank Forms Enter into CERS OUQA- <br /> �,/ Financial Responsibility/Letter from Chief <br /> y� Financial Officer. Due eve 12 months Upload document into CERS 1�1 <br /> Underground Storage Tank J <br /> Monitoringand Response Plans Enter into CERS <br /> Report#5021 Completed 3 q <br /> Designated UST Operator Statement Upload document into CERS <br /> Best Management Practices(BMP's)for Retail <br /> Gasoline Outlets 1 •D.3 .2- 4 <br /> Board of Equalization UST Storage Fee <br /> Account Number Enter into CERS (WkItk <br /> �( Monitoring Certification(go over last MC) <br /> Y� Due very 12 months Jue Qo <br /> –Jq I�2 <br /> 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 /> 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 /> fi UST owner is responsible to see that EHD Submit UST Owner/Operator written agreement(if <br /> J" 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 ' w .� do" y r'� �Q -4 Lolls <br /> Go over last date- Due every 36 months VG�,D <br /> California EPA ID number Enter into CERS will <br /> Hazardous waste generator Permit <br /> Hazardous Materials Management Plan Enter into CERS <br /> Free UST and CUPA Classes Handout ProvidedT d - �. Eo 1 <br /> Consultation by: �— <br />