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V� FEB-02-04 17:27 FROM-KLEEMAN ROESSELEN 916-939-1169 T-746 P.06/1T F-539 II. GENERAL INFORMATION: 1. Obtain an EPA Sire Number Ram the Department of Toxic Substances Control(900)61-TO30C for temporary hazardous waste removal activities associated with underground storage tank(UST)removals. 2 Disposal Information: Public Health Services Underground Storage Tank Disposition Tracking Record(UST Tracking Record,page 10)shall accompany each tank removed from site. Tank(s)will be issued an identification number which PHS-EHD's representative will note on the UST Tracking Record. Contractor wiU affix same idendflcarion number onto tank end using fluorescent spray paint. Contaminated tanks andfor piping are to be transported under Hazardous Waste Manifest by a state registered hazardous waste hauler. 3. Coraracror to Provide Combusrible/Flammable gas detector(to verify the Lower Explosive Limit(LEL)apeosplicre and oxygen level ortank prior to lilting from excavation),adequate number(s)and appropriate typs(s)of fire extinguisher(s),barriers to secure the area as necessary m minimize rraffrc and pedestrian interference,and fluorescent spray paint to affix tank identification numbers. It shall be the project manager's responsibility for compliance with all health&safety regulations and requirements,which shall be strictly adhened to at ea times during rhe course of the closure activities. 4 The PHS-EHD permit shall be on site daring tanit excavation and removal. 5. Any changes in this document shall be approved by PHS-EHD prior to initiating work. 6. Closurain-Place: If Closure-in-Place is the suggested method of abandonment,complete form I EH 23 039 and submit written approval from the local Fire Department. 7. Temporary Closure: IPTemporary Closure is the suggested method of abandonsi ear,complete and submit this form and a wrinen approval Rom the local Fire Department. a. The following documentation shall be submitted within 30 days of the tank removal date: a) Analytical results,mauled directly from laboratory to AHS-EHD,including a chain of custody and quality aw assurance and quality Control(QA&QC). b) UST Tracking Record Sheet(g)and/or Tank Hazardous Waste Maaifest(s)_ c) Tank Closure Certification fort(DISC form 1249). d) 1-1=ardous Waste Manifests for piping,rinaste,residual Anel,or waste an receipt. e) Submit The backfill excavation certificate as required by San Joaquin County and the incorporated City Building Departments, This report will be referred in The appropriate agency for their review. A site which has had UST(s)removed,shall not be considered far final closure undl the above items are submitted for review. Ill, SITE MITIGATION: 1. In the event contamination is observed,confirmed of suspected as a resuh of leaking UST system it is the responsbiliry of the owner or operator to submit a work plan to PM-EM Site Midgation Unit and have it approved prior to initiating any assessment or remediation activities. To minimize dclays, the work plan may be submitted concurtent witlt tank closure or installation pians. Address one copy of the work plan to the Site Mitigation Unit for j rcvic-. If the site is nor currently in the Local Oversight Program a billing form and a$267 miaimum fee must ba { submiaed with the work plan. For Anther assistance contact the Site Mitigation Unit at(209)469-3450. 1J EH 23 046 (Revised 8/l/O1) Page 2 RECEIVED FEB-11-04 15:09 FROM-9168581011 TO-KLEEMAN ROEBBELEN PAGE 04