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If. GENERAL INFORMATION: <br /> 1. Obtain an EPA Site Number from the Department of Toxic Substances Control (8 00) 61-TOXI for <br /> temporary hazardous waste removal activities associated with underground storage tank(UST)re <br /> 2. Disposal Information: SJC EHO's Underground Storage Tank Disposition Tracking Record (UST T <br /> Record, page jo) s 1 accompany each tank removed ftorn cite, Tank(s)will be issued an idonn <br /> number which EHD`s representative will to on the UST Tracking Record. Contractor will affix me <br /> identification number onto tank end using fluorescent spray paint. Contaminated tanks andfor piping a to <br /> be 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 EL) <br /> atmosphere and oxygen level of tank prior to lifting from excavation), adequate nu (s)and a 'ate <br /> type(s) of fire extinguisher(s), barriers to secure the area as necessary to minimize traffic and ped <br /> interference, and fluorescent spray paint to affix tank identification numbers. It shall be the p ct <br /> managers responsibility for compliance with all health&safety regulations and requirements,which sh ll be <br /> strictly 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-Ptace is the suggested method of abandonment,complete form EH 2 39 <br /> and submit written approval from the local Fire Department. <br /> 7. Temporary Closure-, If Temporary Closure is the suggested method of abandonment, complete nd <br /> submit this application and include an explanation of how the UST owner/bperator will comply ith <br /> California Code of Regulations Title 23, Section 2671 (a)-(e). Also, submit a written approval fr the <br /> local Fire Department <br /> 8. The following documentation shall be submitted within 30 days of the tank rem al <br /> date: <br /> 3) Analytic;al results,mailed directly from laboratory to EHD,including a in of custody a quality <br /> assurance and quality control(QA&OC). <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 in rated <br /> City Building Departments. This report will be referred to the appropriate agency for thei view. <br /> A site which has had UST(s)removed,shall not be considered for final closure until the above <br /> are submitted for review. <br /> Ill. SITE MITIGATION: <br /> I. In the event contamination is observed,confirmed or suspected as a result of a leaking UST system is the <br /> responsibility of the owner or operator to submit a work plan to EHD Site Mitigation Unit and ave it <br /> approved prior to initiating any assessment or remediation activities. To minimize delays. the plan <br /> may be submitted concurrent with tank closure or installation plans. Address one copy of the work an to <br /> the Site Mitigation Unit for review. If the site is not currently in the Local Oversight Program. a bbilli form <br /> and a $375 minimum fee must be submitted with the work plan. For fu assistance contact Site <br /> Mitigation Unit at(209)468-3460. <br /> Ell 23 046 (Revised 10130/12) 2 <br />