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V1/ U.JI �uuu VJ. LI LU JYOO JYJJ ! 11 ii � i �JVI\ i t -.VL. VJ II. GENERAL INFORMATION: Obtain an EPA Site Number from the Department of Toxic Substances Control (800) 61 •TOXIC for remporary hazardous waste removal activities associated with underground storage tank (UST) removals. 2. Disposal Information: Public Health Services 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 PHS-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/Flammabie gas detector (to verify the Lower Explosive Limit fLEL) atmosphere and oxygen level of tank prior to lifting from excavation.), adequate numher(s) and appropriate types) 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 clic course of the closure activities - 4 The PHIS-EHD permit shall be on site during tank excavation and removal. 5. Any changes in this document shall be approved by PHS-F'KD 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. Temporary Closure: If Temporary Closure is the suggested method of abandonment, complete and submit this form and a written approval from the local Fire Department. g. The following documentation shall be submitted within 30 days of the tank removal date: a) Analytical results, mailed directly from laboratory to PHS-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. :� site which has had UST(s) removed, sitar[ not be considered for Cmal closure until the above items are submitted for review. Ill. SIT= MITIGATION: 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 PHS -F -HD 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 5234 minimum fee must be submitted with the work plan. For further assistance contact the Site Mitigation Unit at (209) 468-3450. Eli 23 046 (Revised 08/13!99) Page 2