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ARONMENTAL 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: ►vp�t on LAC., Date: <br /> vf� <br /> Title: r I'r-m <br /> Facility Address: Mt\J S.-T jFZiq PR#: 07-3/4-3,T <br /> Completed Task Comments <br /> Er Underground Storage Tanks -Facility Form 6 ► loci <br /> C� <br /> Underground Storage Tanks -Tank Forms 3 Te—%&A X d i FZN VN G ft o 9 <br /> Financial Responsibility/Letter from Chief nn <br /> Financial Officer. Due every 12 months 10 -i <br /> 0/ Underground Storage Tank 1 ( OCA <br /> Monitoringand Response Plans �� t � +V <br /> Ii' Report#5021 Completed <br /> Designated UST Operator Statement t u q <br /> Ljr Best Management Practices(BMP's)for Retail D _ 1_ 6 I I 0 9 <br /> Gasoline Outlets l <br /> Lj/ Board of Equalization UST Storage Fee <br /> Account Number s��� �O l <br /> a Monitoring Certification(go over last MC) Pe� W, Z l ((5 5 <br /> Due very 12 months <br /> L3/I Spill Buckets <br /> Q' Sensors <br /> UK Leak Detectors <br /> Line Test Requirements(if needed or not <br /> for pressurized piping) <br /> Sensor/Leak Detector failures can have Zh^W w'*t , ,d b � <br /> emergency replacement with EHD permit ,T�"�► <br /> obtained within !^yf replacemenis A <br /> 1-4 AA <br /> All other work must have E D 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 a GJv��A�vvtjvw►� +Ca}�r� '�' (� N`° '�`'° <br /> Go over last date - Due every 36 months :t4^�'w`.001"'-4$<� . <br /> California EPA ID number <br /> EK Hazardous waste generator <br /> —/ <br /> LY Hazardous Materials Management Plan <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: &I , <br />