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s <br /> II. GENERAL INFORMATION: <br /> v 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 /> V-'2. Disposal Information: Public Health Services Underground Storage Tank Disposition Tracking Record(UST <br /> Tracking Record, page 10) shall accompany each tank removed from site. Tank(s) will be issued an identification <br /> number which PHS-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 /> V 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 type(s) <br /> of fire extinguisher(s), barriers to secure the area as necessary to minimize traffic and pedestrian interference, and <br /> fluorescent spray paint to affix tank identification numbers. It shall be the project manager's responsibility for <br /> compliance with all health&safety regulations and requirements, which shall be strictly adhered to at all times <br /> during the course of the closure activities. <br /> ✓4 The PHS-EHD permit shall be on site during tank excavation and removal. <br /> c/ o. Any changes in this document shall be approved by PHS-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 <br /> and submit this form and a written approval from the local Fire Department. <br /> 8. The following documentation shall be submitted within 30 days of the tank removal (late: <br /> ✓ a) Analytical results, mailed directly from laboratory to PHS-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(DISC 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 /> .i 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 workplan to PHS-EHD Site Mitigation Unit prior to initiating <br /> any assessment or remediation activities. To minimize delays, a Corrective Action Plan may be submitted <br /> concurrent with tank closure or installation plans. Address one copy of the Corrective Action Plan to the Site <br /> Mitigation Unit for review. For further assistance contact the Site Mitigation Unit at(209)468-3450. <br /> EH 23 046 (Revisedl0/19/98) Page 2 <br />