Laserfiche WebLink
VIRONMENTAL HEALTH DEPARTM CQ <br /> SAN JOAQUIN COUNTY <br /> 1868 E.Hazelton Ave. v I <br /> Stockton,California 95205 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility <br /> Representative: ll�oihj i T6 E A Date: g - L4 <br /> Title: ,��2 S r D L!V <br /> Facility Address: 2Iv -Qo m6 f SR#: 00)400 qq <br /> Completed Task Comments <br /> Underground Storage Tanks-Facility Form Enter into CERS <br /> Underground Storage Tanks-Tank Forms Enter into CERS <br /> Financial Responsibility/Letter from Chief l <br /> Financial Officer. Due every 12 months Upload document into CERS, b inne r <br /> Underground Storage Tankpn <br /> Monitoringand Response Plans Enter into CERS taq ckc oo ni C , <br /> Report#5021 Completed p1 <br /> Designated UST Operator Statement Upload document into CERS lJJ1 (°.t/�2.(�,�.. �Jl�l`�- <br /> Best Management Practices(BMP's)for Retail C? <br /> Gasoline Outlets <br /> Board of Equalization UST Storage Fee <br /> Account Number Enter into CERS d cef C6 <br /> Monitoring Certification(go over last MC) <br /> Due every 12 months <br /> Spill Buckets <br /> Sensors/Leak Detectors <br /> -$ Line Test Requirements(if needed or not <br /> for pressurized pi ping) <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 Submit UST Owner/Operator written agreement(if <br /> permits are properly obtained. applicable). Can upload document to CERS <br /> Required to create a CERS account at <br /> cers.calepa.ca.gov Provide Lead User Authorization Form <br /> Secondary Containment Requirements <br /> Go over last date- Due every 36 months <br /> California EPA ID number Enter into CERS <br /> Hazardous waste generator Permit <br /> Hazardous Materials Management Plan <br /> Enter into CERS <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: -E�2'I 0- �Q n <br /> S YIRLd s --o 4)e 0-U QAA et- ctcove ci cl-C iso i C)Q s re-'W04 <br />