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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: <br /> PR# TANK# UL#ZOZ at TANK MODEUMATERIAL: <br /> COMPARTMENTALIZED TANK? (If yes, complete one form for each tank) ❑YES j(NO /1 <br /> TANK CAPACITY: OdO PRODUCT: <br /> DATE A INITIALS <br /> P <br /> R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> v SPECIFICATIONS <br /> E <br /> 0 <br /> 1. UST PLANS SUBMITTED AND FEES PAID (H&S CODE SECTION 25287 <br /> 2. UST INSTALLATION PLANS APROVED <br /> INITIAL INSPECTIONS <br /> „/�� 3. INSPECTION AND TEST OF SECONDARY CO MENT:HOLIDAY TEST: VACUUM: <br /> `� SOAP: PSI: HRS/MIN: BRIN LI UID ANNULAR): OTHER: <br /> 0 4. PRIMARY TANK TEST: <br /> ia3 i 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL API/PEI <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST MINIMUM 40 PSI/30 MIN v :h CCR 2636(e)] <br /> I JW 7. SECONDARY PIPING CONTAINMENT TEST: PSI: HRS/MIN: dIOTHER: CCR 2636 e <br /> 8. LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: CCR 2635 a 4 <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10.OVERSPILL PERFORMANCE TEST rCCR 2635 b 1 C <br /> 11.ALL PIPING AND FITTINGS CORROSION PROTECTED ICCR 2636 b <br /> 12. PIPING SLOPES TO COLLECTION SUMP FCCR 2636 c 1 <br /> FINAL INSPECTION <br /> 1 0 13. PERFORMANCE TEST FOR"ALL"MONITORING PROBES ICCR 2632 c 2 <br /> \ 0 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM CCR 2632 c 2 <br /> t 15. PERFORMANCE TEST OF LINE LEAK DETECTION CCR 2643 c 1 11 <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF FCCR 2636 <br /> R.Jf t4;W S -CqU, 1 17. BALL FLOAT VALVES INSTALLED <br /> 7126N Vi 1 10 18. OVERFILL PROTECTION INSTALLED AND APPROVED FCCR 2635 b 2 <br /> U 19. TANK ACCESS PORTS BROUGHT TO GRADE LOCKED AND WATERTIGHT API <br /> ✓ 20. TANK INTEGRITY TEST PERFORMED HARD COPY SUBMITTED CCR 2635 a 5 <br /> 21. MONITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE FCCR 2632 d <br /> 22."C"FORM COMPLETED AND SUBMITTED FCCR 2635 d <br /> u 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED fCCR 2630-2636 <br /> 24. ALL CONDITIONS MET: FACILITY PERMIT ISSUED H&S CODE 25284 <br /> COMMENTS <br /> EH23 006 3/18/02 <br /> 10 <br />