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Environmental Management <br />Department <br />Val F. Siebal, Director <br />Divisions <br />Environmental Compliance <br />RECEIVEDironmental Health <br />County of Sacramento ENVIRONMENTAL <br />TnA[:'T <br />UST FORM(S) SUBMITTAL OPTIONS <br />The table below provides the UST form(s) submittal options (X). Some UST data must be typed into the Portal (Column 1). <br />Some information must be uploaded to the portal as PDF documents (Column 2). In some cases the user can decide to type <br />data or upload information (Column 3). And in other cases the required data may be provide elsewhere in Portal (Column 4). <br />UST FORMS 1 2 '3 4 <br />Operating Permit Application - Facility information (formally known as UPCF A). This is the 'UST X <br />Operating Permit Application' <br />Operating Permit Application — Tank information (formally known as UPCF B). Note this X <br />information must be entered for each tank (or compartment for compartmentalized tanks). So if there are 3 <br />USTs at the site, this must be completed 3 times, one for each UST <br />Certification of Installation/Modification (Formally known as UPCF C). <br />UST Monitoring Plan (Formally known as UPCF D Note — this information must be entered for each tank <br />(or compartment for compartmentalized tanks). So if there are 3 USTs at the site, this must be completed 3 <br />times, one for each UST <br />UST Response Plan (Formally known as Form Q. Note that if applicable information is provided in another <br />response plan such as the HMBP Emergency Response Plan and Training Plan the business may indicate so in <br />the 'Upload Document' section (Use the 'Provided elsewhere' link) rather than upload a UST Response Plan. <br />Financial Responsibility Certification <br />Owner Statement of Designated UST Operator Compliance. This is the 'Owner Statement of <br />Designated UST Operator Compliance' <br />UST Owner/Operator: Written Agreement <br />Facility Plot Plan. This is the 'UST Monitoring Site Plan.' Note the applicable information may be provided <br />in another site map such as the HMBP site map <br />Letter from Chief Financial Officer <br />Monitoring System Annual Certification <br />Spill Bucket Testing Report <br />Secondary Containment Testing Report <br />Tank Integrity Test Report <br />Line Integrity Test Report <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X X <br />X <br />X <br />X <br />Enhanced Leak Detection Test Report X1 I <br />Statistical Inventory Reconciliation Annual Results Statement X <br />10590 Armstrong Ave. Suite A • Mather, CA 95655 • phone (916) 875-8550 • fax (916) 875-8513 • www.emd.saccounty.net <br />