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N <br /> Lr., <br /> II. GENERAL INFORMATION: <br /> 1. Obtain an EPA Site Number from the Department of Toxic Substances Control (800) 61-TOXIC for temporary <br /> hazardous waste removal activities associated with underground storage tank(UST)removals. <br /> 2. Disposal Information: Public Health Services Underground Storage Tank Disposition Tracking Record(UST <br /> Tracking Record,page 10)shall accompany each tank removed from site. Tank(s)will be issued an identification <br /> number which PHS-EHD's representative will note on the UST Tracking Record. Contractor will affix same <br /> identification number onto tank end using fluorescent spray paint. Contaminated tanks and/or piping are to be <br /> transported under Hazardous Waste Manifest by a state registered hazardous waste hauler. <br /> 3. Contractor to Provide: Combustible/Flammable gas detector(to verify the Lower Explosive Limit(LEL) <br /> atmosphere and oxygen level of tank prior to lifting from excavation), adequate number(s)and appropriate type(s)of <br /> fire extinguisher(s),barriers to secure the area as necessary to minimize traffic and pedestrian interference, and <br /> fluorescent spray paint to affix tank identification numbers. It shall be the project manager's responsibility for <br /> compliance with all health&safety regulations and requirements, which shall be strictly adhered to at all times <br /> during the course of the closure activities. <br /> 4 The PHS-EHD permit shall be on site during tank excavation and removal. <br /> 5. Any changes in this document shall be approved by PHS-EHD prior to initiating work. <br /> 6. Closure-in-Place: If Closure-in-Place is the suggested method of abandonment, complete form <br /> EH 23 039 and submit written approval from the local Fire Department. <br /> 7. Temporary Closure: If Temporary Closure is the suggested method of abandonment, complete <br /> and submit this form and a written approval from the local Fire Department. <br /> g. The following documentation shall be submitted within 30 days of the tank removal date: <br /> a) Analytical results, mailed directly from laboratory to PHS-EHD, including a chain of custody and quality <br /> assurance and quality control (QA&QC). <br /> b) UST Tracking Record Sheet(s) and/or Tank Hazardous Waste Manifest(s). <br /> C) Tank Closure Certification Form (DTSC form 1249). <br /> d) Hazardous Waste Manifests for piping, rinsate, residual fuel, or waste oil receipt. <br /> C) Submit the backfill excavation certificate as required by San Joaquin County and the incorporated City <br /> Building Departments. This report will be referred to the appropriate agency for their review. <br /> A site which has had UST(s) removed, shall not be considered for final closure until the above items are <br /> submitted for review. <br /> III. SITE MITIGATION: <br /> 1. In the event contamination is observed, confirmed or suspected as a result of a leaking UST system it is the <br /> responsibility of the owner or operator to submit a work plan to PHS-EHD Site Mitigation Unit and have it approved <br /> prior to initiating any assessment or remediation activities. To minimize delays, the work plan may be submitted <br /> concurrent with tank closure or installation plans. Address one copy of the work plan to the Site Mitigation Unit for <br /> review. If the site is not currently in the Local Oversight Program, a billing form and a$261 minimum fee must be <br /> submitted with the work plan. For further assistance contact the Site Mitigation Unit at(209)468-3450. <br /> EH 23 046 (Revised 09/21/00) Page 2 <br />