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® ;925 551 7888 # 24/ 34 <br /> 5-27-04; 8:43AM; <br /> 03/05!2004 13:59 2094683433 FIFTH FLOOR PAGE 06 <br /> 11. GENERAL INFORMATION: <br /> t. Obtain an EPA Site Number(corn 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 Infomiation: Public Health Services Underground Storage Tank Aisposition Tmclgbg Record(UST Tracking <br /> 1Record,page 10)sh4ll accompany each tank removed from site. Tank(s)wilt be issued an identification number which <br /> PHS-EHD°s representativr will now on the UST Tracking Record. Contractor will affix same identification auraber <br /> onto tank cad using fluorescent spray paint.•Contaminated kaks and/or piping are to be transported under Hazardous <br /> Waste.Manifest by a state registered hazardous waste hauler_ <br /> 3. Contractor to Provide; Combustible/Flamtxa$ble gas detector(to verify the Lower Explosive Limit(LEL)aiwasphere <br /> and oxygen level of tank prior to lifting from excavation),adequate bcr(s)and appropriate types)of fire <br /> estinguisher(s),bacricrs to secure the area as necessary to winirnize traffic and pedestrian interference,and fluorescent <br /> spray paidt to affix tank identification numbers_ It shalt be the project rnanagces responsibility for compliance with all <br /> ` health&safety regulations and requirements,which shall be strictly adhered to at all times during the course of the <br /> closure activities. <br /> 4 The PHS-EHD permit shall be on site during tank excavation and removal- <br /> s. Any changes In this document shall be approved by PHS- D prior to initiating work. a <br /> 6. Closure-in-$lace: If Closure-in-Place is the suggested method ofabandorustent,complete form <br /> EH 23 039 and submit written approval from the local Fire Department <br /> he este method of abandorunent eo leve <br /> 7. Temporary Closure: If Temporary Closure as t Sugg d mp <br /> and submit this form and a written approval from the local Fire Department. <br /> S. The following documentation shall be submitted within 30 days of the tank removal date: <br /> i <br /> a) Analytical results,mafted dircctly from laboratory to PHS-EHD,in=cluding 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 Manifost(s). j <br /> C) Tank Closure Certification Form(DTSC form 1.249). <br /> d) Hazardous Waste Manifests•f:or piping,Arcate,residual fuel,or waste oil receipt. <br /> C) Submit the bnekfUl excavation certificate as requited by San Joaquin County and the inemporated City <br /> Building Departments. Tbls report will be Refected 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!caking UST system it is the <br /> responsibility of the owner or operator to submit a workplan to PISS-BW Site Mitigation Unit and have it approved <br /> prior to initiating any assessment or remodiation activities. To miaimize delays,the workplan may be submitted <br /> concurrent with tank closure or installation plans. Address one copy ofthc work plan to the Sit*Mitigations Unit for. <br /> review. If the site is not currently in the Local Oversight Program,a billing,Form and 2.5267 rninimurn fee must be <br /> submitted with the work plan. For further asslstance contact the Site Mitigation Unit at(209)468-3450- <br /> 1"--'23046 (Revised 8/1101) Page 2 <br />