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OVIRONMENTAL HEALTH DEPARTME'• <br />SAN JOAQUIN COUNTY <br />1868 E. Hazelton Ave. <br />Stockton, California 95205 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />UST Consultation Checklist <br />Facility <br />Representative: <br />Title: <br />Date: '-1 -0+0'2014 <br />Facility Address: ) 601 -Av21y)Qy to L' 0-- SR#: 00400779 <br />Compl Task Comments <br />Underground Storage Tanks -Facility 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 />Designated UST Operator Statement <br />Upload document into CERS <br />pq�( <br />Best Management Practices (BMP's) for Retail <br />Gasoline Outlets <br />Board of Equalization UST Storage Fee <br />Account Number <br />Enter into CERS <br />Monitoring Certification (go over last MC) <br />Due very 12 months <br />lY <br />Spill Buckets <br />Sensors/ Leak Detectors <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 />permits are properly obtained. <br />Submit UST Owner/Operator written agreement(if <br />applicable). Can upload document to CERS <br />Required to create a CERS account at <br />cers.calepa.ca.gov <br />Provide Lead User Authorization Form <br />Secondary Containment Requirements <br />Go over last date - Due every 36 months <br />California EPA ID number <br />Enter into CERS <br />Hazardous waste generator Permit <br />Hazardous Materials Management Plan <br />Enter into CERS <br />/ <br />f� <br />Free UST and CUPA Classes Handout Provided <br />Consultation by: e�lU Na VIC-L�Q <br />