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WIRONMENTAL HEALTH DER 'M SAN JOAQUIN COUNTY 1868 E. Hazelton Ave. Stockton, California 95205 Telephone: (209) 468-3420 Fax: (209) 468-3433 UST Consultation Checklist Facility n_ Representative: ka kL a 14 aa, Date: Qek3) 12-00 Title: Facility Address: C « Task Comments Underground Storage Tanks -Facility Form Enter into CERS ile ®ij 0 `e -i Under round Storage Tanks -Tank Forms Enter into CERS ® Financial Responsibility/Letter from Chief Financial Officer. Due every 12 months Upload document into CERS Underground Storage Tank Monitoring and Response Plans Enter into CERS Report #5021 Completed ❑ Designated UST Operator Statement Upload document into CERS Best Management Practices (BMP's) for Retail Gasoline Outlets ® Board of Equalization UST Storage Fee Account Number Enter into CERS Monitoring Certification (go over last MC) Due every 12 months ❑ Spill Buckets ❑ Sensors/ Leak Detectors ® Line Test Requirements (if needed or not for pressurized piping) Sensor/Leak Detector failures can have ❑ emergency replacement with EHD permit obtained within of replacement ® All other work must have EHD permit prior to work being performed ❑ UST owner is responsible to see that EHD Submit UST Owner/Operator written agreement(if permits are properly obtained. applicable). Can upload document to CERS ❑ Required to create a CERS account at cers.calepa.ca.gov Provide Lead User Authorization Form ® Secondary Containment Requirements Go over last date - Due every 36 months ❑ California EPA ID number Enter into CERS ❑ Hazardous waste generator Permit ❑ Hazardous Materials Management Plan Enter into CERS ❑ Free UST and CUPA Classes Handout Provided Consultation by: 10"a- I ►' Iwww