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' 'VIRONMENTAL HEALTH DEPARTMEN'- <br /> SAN JOAQUIN COUNTY Ye-rxq-5 <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: �, 1, n Date: -7-3,f::, <br /> Title: <br /> oz37— <br /> Facility Address: !—f 3lS G—,)A/-r,/." gj PR#: oSr�S�fi�t H4. <br /> Completed Task Comments <br /> Underground Storage Tanks-Facility Form <br /> `9, Underound Storage Tanks-Tank Forms <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months <br /> Underground Storage Tank <br /> Monitoring and Response Plans <br /> Report#5021 Completed <br /> 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 /> Monitoring Certification(go over last MC) <br /> Due every 12 months 6 0 -j x cTN t'►� G <br /> Spill Buckets <br /> Sensors <br /> Leak Detectors <br /> Line Test Requirements(if needed or not <br /> for pressurized piping) 1 <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 <br /> permits are properly obtained <br /> Secondary Containment Requirements <br /> Go over last date- Due every 36 months ��� 4— <br /> California <br /> -California EPA ID number <br /> Hazardous waste generator <br /> Hazardous Materials Management Plan <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />