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VIRONMENTAL HEALTH DEPARTME <br /> SAN JOAQUIN COUNTY <br /> 304 East Weber Avenue,Third Floor <br /> Stockton,California 95202 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> UST Consultation Checklist <br /> Facility L r <br /> Representative: (� 'r Date: <br /> Title: <br /> Facility Address: } lfPR#: <br /> Comply Task Comments <br /> Xnderground Storage Tanks-Facility Form <br /> J.?nderground Storage Tanks-Tank Forms <br /> Financial Responsibility/Letter from Chief <br /> Financial Officer. Due every 12 months <br /> Underground Storage Tank <br /> Monitoring and Response Plans <br /> port#5021 Completed <br /> Designated UST Operator Statement <br /> Best Management Practices(BMP's) for Retail <br /> asoline Outlets <br /> Board of Equalization UST Storage Fee <br /> Account Number <br /> -'Monitoring Certification(go over last MC) <br /> Due every 12 months <br /> ❑ Spill Buckets <br /> ❑ Sensors <br /> ❑ 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 /> Secondary Containment Requirements <br /> Go over last date- Due every 36 months <br /> California EPA ID number <br /> Hazardous waste generator <br /> ❑ Hazardous Materials Management Plan <br /> Free UST and CUPA Classes Handout Provided <br /> Consultation by: <br />