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VIRONMENTAL HEALTH DEPARTMEO <br /> SAN JOAQUIN COUNTY <br /> 600 E.Main Street <br /> Stockton,Califomia 95202 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility <br /> Representative: 2i k�� _ Date: ^ <br /> Title: <br /> Facility Address: 8,�l V obey IA4-P -AyQ , Ao.cA&acL— PR#: Q�, 8'a-A� <br /> Completed Task Comments <br /> El Underground Storage Tanks-Facility Form VrA vi <br /> Underground Storage Tanks-Tank Forms <br /> ❑/ Financial Responsibility/Letter from Chief I Financial Officer. Due eve R 12 months �(R� h"U ap <br /> Underground Storage Tank I� 1 <br /> Monitoring and Response Plans <br /> Report#5021 Completed <br /> 4nDesignated UST Operator Statement '� OlJh2y b Y\Q�tPfP <br /> est Management Practices(BMP's)for Retailasoline Outletsoard of Equalization UST Storage Feeccount Numberonitoring Certification(go over last MC) <br /> :Due very 12 months <br /> Ur Spill Buckets $ 6 , g _ 0 19 <br /> / Sensors — � I— <br /> L� Leak Detectors <br /> ❑ Line Test Requirements(if needed or not <br /> for pressurized piping) <br /> Sensor/Leak Detector failures can have <br /> ❑ emergency replacement with EHD permit <br /> obtained within LJaM 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 <br /> permits are properly obtained <br /> Secondary Containment Requirements L�} n e d '2S 1 �U d 1 S <br /> Go over last date- Due every 36 months + Coln.dUC� <br /> California EPA ID number 'Fu M o\ro a PArj <br /> Hazardous waste generator PrcoyiaeA W <br /> IEC Hazardous Materials Management Plan W o vtd ed }A :02PAr. <br /> Y. l� � <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: E: ' ffi0'y W'0 <br />