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NEL UST INSTALLATION INSPECTION RECORD <br /> NAME: ADDRESS: 176 <br /> �ILITY ID# TAN K# J UL# �00 /3 TANK MODEL/MATERIAL:— <br /> CAPACITY: CTZf?) PRODUCT: —Dgza R.E.H.S: „yJ <br /> A I �'/� <br /> P 4 ALL TANKS TO 3E INSTALLED AND TESTED IN ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 I <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> 1. UST PIANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY- <br /> VACUUM:Zo <br /> OLIDAY:VACUUM:Zo SOAP: PSI: HRS/MIN: 3RINE(LIOUID ANNULAR): OTHER: <br /> 7 4. PRIMARY iANK TEST: PSI: HRS/MIH: ( <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> �.__�.6�' b. PRIMARY PIPING TEST (MINIMUM 40 PSII30 MIN) �7� SCM,..- (CCR 2636 (e)) <br /> 1Z -"a / 1 7. SECONDARY PIPING CONTAINMENT TEST PSI: V HRS/MIN�,i�:O OTHER: (CCR 2636 (e)) <br /> V <br /> oy7 V� 'i LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br /> 111;17 <br /> � 11. J tA, 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 41l--t O 1 I / 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> j 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> M� 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> VVVfff FINAL INSPECTION <br /> V1 P PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> W ✓ el, 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> W 15.._ PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> ,_PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br /> 17. BALL FLOAT VALVES INSTALLED <br /> 1 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 1 L 1 <br /> V4". TANK ACCESS PORTS 3ROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> f!_26 l/ Iq 20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> 11 ��(,j-� ✓ 4�"21. MONITORING PLAN, RESPONSE PLAN AND LOG 300K ON SITE (CCR 2632 (d)) <br /> 22. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> 24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMEN : <br /> s ¢` - <br /> I : <br /> f c� <br /> E1123--006 9/95 T <br />