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SANr10AQ U I N Environmental Health Department — COUNT 01) ^> II. ERAL INFORMATION: 1 . Obtain an EPA Site Number from the Department of Toxic Substances Control (800) 614OXIC for temporary hazardous waste removal activities associated with underground storage tank (UST) removals. 2. Disposal Information: SJC EHD's 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 EHD's representative will note on the UST Tracking Record. Contractor will affix same identification number onto tank end using fluorescent spray paint. Contaminated tanks and/or piping are to be transported under Hazardous Waste Manifest by a state registered hazardous waste hauler. 3. Contractor to Provide: Combustible/Flammable gas detector (to verify the Lower Explosive Limit (LEL) atmosphere and oxygen level of tank prior to lifting from excavation), adequate number(s) and appropriate type(s) of fire extinguisher(s), barriers to secure the area as necessary to minimize traffic 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 adhered to at all times during the course of the closure activities. 4 The EHD permit shall be on site during tank excavation and removal. 5. Any changes in this document shall be approved by EHD prior to initiating work. 6. Closure-in-Place: If Closure-in-Place is the suggested method of abandonment, complete form EH 23 039 and submit written approval from the local Fire Department. 7, Temporary Closure: If Temporary Closure is the suggested method of abandonment, complete and submit this application and include an explanation of how the UST owner/operator will comply with California Code of Regulations Title 23, Section 2671 (a)-(e). Also, submit a written approval from the local Fire Department, 8. The following documentation shall be submitted within 30 days of the tank removal date: a) Analytical results, mailed directly from laboratory to EHD, including a chain of custody and quality assurance and quality control (QA & QC). b) UST Tracking Record Sheet(s) and/or Tank Hazardous Waste Manifest(s). C) Tank Closure Certification Form (DTSC form 1249). d) Hazardous Waste Manifests for piping, rinsate, residual fuel, or waste oil receipt. e) Submit the backfill excavation certificate as required by San Joaquin County and the incorporated City Building Departments. This report will be referred to the appropriate agency for their review. A site which has had UST(s) removed, shall not be considered for final closure until the above items are submitted for review. III. SITE MITIGATION: 1 . In the event contamination is observed, confirmed or suspected as a result of a leaking UST system it is the responsibility of the owner or operator to submit a work plan to EHD Site Mitigation Unit and have it approved prior to initiating any assessment or remediation activities. To minimize delays, the work plan may be submitted concurrent with tank closure or installation plans. Address one copy of the work plan to the Site Mitigation Unit for review. If the site is not currently in the Local Oversight Program, a billing form and a $456 minimum fee must be submitted with the work plan. For further assistance contact the Site Mitigation Unit at (209) 468-3420. 2 of 10