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ANVIRONMENTAL HEALTH DEPARTMEN, 01k <br />SAN JOAQUIN COUNTY <br />600 E. Main Street <br />Stockton, California 95202 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />Facility <br />Representative: �6'-' V4( ii <br />Title: <br />Facility Address: <br />Date: II t V <br />PR#: ?j q <br />Co plated Task Comments <br />Underground Storage Tanks -Facility Form <br />Underground Storage Tanks -Tank Forms <br />Financial Responsibility/Letter from Chief <br />Financial Officer. Due eve 12 months <br />ets W VICt m 41- <br />d lM 94 V t bw;% �/ 0 <br />Underground Storage Tank <br />Monitoring and Response Plans <br />Report #5021 Completed <br />Designated UST Operator Statement <br />6mty NiII j(N(/fww �/ 10 1410-1 <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 />Ci <br />Spill Buckets <br />Sensors <br />Leak Detectors <br />-/ <br />LXP <br />Line Test Requirements (if needed or not <br />for pressurized piping) <br />�j <br />Sensor/Leak Detector failures can have <br />emergency replacement w,,�hEHD permit <br />obtained within I Oreplacement <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 />l'J <br />Secondary Containment Requirements <br />Go over last date - Due every 36 months <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 />