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OVIRONMENTAL HEALTH DEPARTMES <br /> (--AA (--A,cf---12'-t -1 SAN JOAQUIN COUNTY <br /> 1868 E.Hazelton Ave. -Zp� �6� ods <br /> Stockton,California 95205 / D <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility <br /> Representative: ,-,.,,' (��,�o,(`,,,,�,1 Date: <br /> Title: ��t��re�"•. �'�'' N ,� <br /> Facility Address: oE, r SR#: 40 66 <br /> CO-411 d Task Comments <br /> LA J Underground Storage Tanks-Facility Form Enter into CERS <br /> Wr Underground Storage Tanks-Tank Forms Enter into CERS <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months Upload document into CERS <br /> Underground Storage-Tank <br /> onitorin an es onse Plans Enter into CERS Llpt a,A <br /> Report#5021 Completed <br /> LO Designated UST Operator Statement Upload document into CERS <br /> Best Management Practices(BMP's)for Retail <br /> Gasoline Outlets <br /> r� Board of Equalization UST Storage Fee <br /> Account Number Enter into CERS 5 <br /> Monitoring Certification(go over last MC) <br /> Due every 12 months <br /> &' Spill Buckets <br /> Sensors/Leak Detectors <br /> Line Test Requirements(if needed or not <br /> for pressurized piping) <br /> r Sensor/Leak Detector failures can have <br /> [� emergency replacement with EHD permit <br /> obtained within of replacement <br /> dAll 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 /> Secondary Containment Requirements <br /> Go over last date- Due every 36 months Vv l/' <br /> I California EPA ID number Enter into CERS <br /> / Hazardous waste generator Permit <br /> fa Hazardous Materials Management Plan Enter into CERS <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />