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. ................ <br /> .... .. .......... <br /> WHIONMENTAL HEALTH DEPARTME <br /> SAN JOAQUIN COUNTY <br /> 600 E.Main Street <br /> Stockton,California 95202 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility <br /> Representative: V, '01 Date:A, <br /> Title: AC <br /> Facility Address: C PR#: 0 <br /> Completed Task Comment <br /> ✓ Underground Storage Tanks-Facility Form 4?ay. i've, <br /> Underground Storage Tanks-Tank Forms <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months i9W&U- /;44 <br /> Underground Storage Tank <br /> Monitoring and Response Plans f M4 D-0 <br /> Report#5021 Completed 3.1-65e a-yk �-1;26 jZv ? <br /> Ll Designated UST Operator Statement <br /> Best Management Practices(BMP's)for Retail <br /> Gasoline Outlets <br /> Board of Equalization UST Storage Fee <br /> Account Number <br /> tl Monitoring Certification(go over last MC) <br /> V Due eve 12 months <br /> Spill Buckets <br /> W/ /sensors <br /> P/ Leak Detectors -�O--U(C <br /> z(.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. daV 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 <br /> —Go over last date- Due every 36 months A) Z— rTCiWCk <br /> California EPA ID number 0 U-,) <br /> Hazardous waste generator recorA lAus- cry L-hp <br /> Hazardous Materials Management Plan (0)& <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />