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IRONMENTAL HEALTH DEPARTMEl� <br />SAN JOAQUIN COUNTY <br />600 E. Main Street <br />Stockton, Califomia 95202 <br />Telephone: (209),M8-3420 Fax: (209) 468-3433 <br />UST Consultation Checklist <br />Facility <br />Representative: M kN '� E k 1i b (Z &m l Date: l to d <br />Title: IBJ L <br />Facility Address: J 00 j E YO SIE -M I M A-LrE-Wt,. WAAjr-eA- PR#: <br />Completed Task Comments <br />Underground Storage Tanks -Facility Form <br />Underground Storage Tanks -Tank Forms <br />Financial Responsibility/Letter from Chief <br />Financial Officer. Due every 12 months <br />d <br />Underground Storage Tanka� <br />Monitoringand Response Plans <br />�► <br />N�" ""' <br />Report #5021 Completed <br />�„�r-cc,oL•1 G�.�al <br />Designated UST Operator Statement <br />Best Management Practices (BMP's) for Retail <br />Gasoline Outlets <br />dBoard <br />of Equalization UST Storage Fee <br />Account Number <br />Monitoring Certification (go over last MC) <br />Due very 12 months <br />W� 2 I a�-�► <br />f� <br />Spill Buckets <br />[� <br />Sensors <br />Leak Detectors <br />Line Test Requirements (if needed or not <br />for pressurized piping) <br />Cid' <br />Sensor/Leak Detector failures can have <br />emergency replacement with EHD permit <br />obtained within of replacement <br />d <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 />Secondary Containment Requirements <br />Go over last date - Due every 36 months <br />Ca' <br />California EPA ID number <br />W l LA, rr v vt <br />Lir <br />Hazardous waste generator <br />3 <br />Hazardous Materials Management Plan <br />Cry <br />Free UST and CUPA Classes Handout Provided <br />NYS" T-f� U" 3 4.«(,,,,,Q{ <br />Consultation by: W\ ' kf�l r>4,/l <br />