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TVIRONMENTAL HEALTH DEPARTMEP <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 P _ <br /> Representative: 1,61 Date: "��46 <br /> Title: <br /> Facility Address: f(.e*WA PR#: <br /> Completed Task Comments <br /> El Underground Storage Tanks-Facility Form <br /> LIC Underground 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 /> 1 Report 95021 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 /�d Q, <br /> Monitoring Certification(go over last MC) <br /> Due eve 12 months �p <br /> I� Spill Buckets 0g <br /> ® Sensors S-71-0% <br /> U1 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-2A�, —of replacement <br /> Ll 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 <br /> California EPA ID number <br /> Hazardous waste generator <br /> U Hazardous Materials Management Plan <br /> 0 Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />