Laserfiche WebLink
Facility <br />Representative: <br />Title <br />Facility Address <br />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 />ON <br />Date: 1L-241 <br />f1/1 <br />X77 / Gt, SR#: 5.00 ( c/SD <br />Completed Task Comments <br />Ul'� <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 />®/ <br />Underground Storage Tank <br />Monitoring and Response Plans <br />Enter into CERS <br />f� <br />Report #5021 Completed <br />O'� <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 />DWra.,° <br />Account Number <br />Enter into CERS <br />Monitoring Certification (go over last MC) <br />Due every 12 months <br />Spill Buckets <br />Chi <br />Sensors/ Leak Detectors <br />Ks/pr <br />Line Test Requirements (if needed or not <br />WA <br />for pressurizedpiping) <br />Sensor/Leak Detector failures can have <br />Ga", <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 />?,//!;/// <br />Go over last date - Due every 36 months <br />California EPA ID number <br />Enter into CERS <br />C( <br />Hazardous waste generator Permit <br />56'- <br />Hazardous Materials Management Plan <br />Enter into CERS <br />❑ <br />Free UST and CUPA Classes Handout Provided <br />PrD lt_d <br />Consultation by: W <br />