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0 <br />11. GENERAL INFORMATION: <br />0 <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: SIC EHD's Underground Storage Tank Disposition Tracking Record (UST Tracking <br />Record, page 10) shall accompany each tank removed from site. Tank(s) will be issued an identification <br />number which 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 <br />type(s) of fire extinguisher(s), barriers to secure the area as necessary to minimize traffic and pedestrian <br />interference, and fluorescent spray paint to affix tank identification numbers. It shall be the project manager's <br />responsibility for compliance with all health & safety regulations and requirements, which shall be strictly <br />adhered to at all times during the course of the closure activities. <br />4 The EHD permit shall be on site during tank excavation and removal. <br />5. Any changes in this document shall be approved by 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 and submit <br />this application and include an explanation of how the UST owner/operator will comply with California Code <br />of Regulations Title 23, Section 2671 (a) -(e). Also, submit a written approval from the local Fire Department. <br />8. The following documentation shall be submitted within 30 days of the tank removal date: <br />a) Analytical results, mailed directly from laboratory to 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 />e) 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 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 <br />for review. If the site is not currently in the Local Oversight Program, a billing form and a $285 minimum fee <br />must be submitted with the work plan. For further assistance contact the Site Mitigation Unit at (209) 468-3450. <br />EH 23 046 (Revised 11/21/06) 2 <br />