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Emir& ' ED KF= L; B V II . GENERAL INFORMATION : SEP 2 8 2016 t . Obtain an EPA Site Number from the Department of Toxic Substances Control (800) 61 -TOXIC for temporary hazardous waste remuv_. I activities associated 1.,rith underground store `EINEALTH ?_ . Disposal Information : SJC EHD ' s Underground Storage Tank Disposition Tracking RX? RTM Ring Record , page 10) shall accompany each tank removed from site . Tank(s) vvill be issued an identification number which EHD's representative ;.ill r ► cte on the UST Tracking Record . Contractor will affix same identificamioli number onto tank end using fluorescent spray paint. Contaminated tanks and/o► piping are to be transported under Hazardous Waste Manifest by a state registered h ^zardous 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 Closure4i 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 Iobserved , 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 $417 minimum fee must be submitted with the work plan . For further assistance contact the Site Mitigation Unit at (209) 468-3450 . EH 23 046 (Revised 7/26/2016) 2