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R61 <br />0 <br />IRONMENTAL HEALTH DEPA&ME <br />SAN JOAQUIN COUNTY MW <br />1868 E. Hazelton Ave. <br />Stockton, California 95205 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />UST Consultation Checklist <br />Facility n_ <br />Representative: Ra , � �1� Date: 0031,2-00 <br />Title: <br />Facility Address: LI <br />Completed Task Comments <br />Underground Storage Tanks-Facifity Form <br />Enter into CERS <br />Underground Storage Tanks -Tank Forms <br />Enter into CERS <br />Financial Responsibility/Letter from Chief <br />Financial Officer. Due every 12 months <br />Upload document into CERS <br />Underground Storage Tank <br />Monitoring and Response Plans <br />Enter into CERS <br />Report #5021 Completed <br />❑ <br />Designated UST Operator Statement <br />Upload document into CERS <br />Best Management Practices (BMP's) for Retail <br />Gasoline Outlets <br />Board of Equalization UST Storage Fee <br />' L <br />Account Number <br />Enter into CERS '��•�1� "t <br />Monitoring Certification (go over last MC) <br />nn'' ', T� <br />e ck& 4 <br />Due eve 12 months <br />"J 9i�y <br />I <br />Spill Buckets <br />0. GQM WL <br />Sensors/ Leak Detectors <br />® <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 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 />Submit UST Owner/Operator written agreement(if <br />permits are properly obtained. <br />applicable). Can upload document to CERS <br />o® <br />Required to create a CERS account at <br />cers.calepa.ca.gov <br />Provide Lead User Authorization Form <br />Secondary Containment Requirements <br />P64 &qe <br />Go over last date - Due every 36 months <br />❑ <br />California EPA ID number <br />Enter into CERS <br />Hazardous waste generator Permit <br />❑ <br />Hazardous Materials Management Plan <br />Enter into CERS <br />7�kl <br />Free UST and CUPA Classes Handout Provided <br />Consultation by: 10 0- I ►' IOt.a?ID . <br />