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ENVIRONMENTAL HEALTH DEPARTMENT <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: /4441 fir tl Date: 7 2d�p <br /> Title: (Gd Gnu K/ ^"` G t arfiT� ` �-p� <br /> Facility Address: (,` b (AJ r��, (il/a�j ��t,� PR#: d 2,?l(JJ J <br /> Completed Task Comments <br /> Underground Storage Tanks -Facility Form <br /> Underground Storage Tanks-Tank Forms <br /> y� 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 0&'40L 'C'V;ti <br /> ❑ Designated UST Operator Statement ��` 40. f 4re j <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 <br /> Spill Buckets <br /> V Sensors <br /> ❑ Leak Detectors /V p tcv--L, <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 Z"/�'/'[, 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 C <br /> ❑ California EPA ID number <br /> Hazardous waste generator <br /> Hazardous Materials Management Plan <br /> 111/1 <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: P-2,8 L-1 Un <br /> C kc-q �-Z 4LILi(-f I <br />