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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: - <br /> FACILITY ID# ADDRESS• <br /> CAPACITY: UL# <br /> 1'���g TANK MODEL/MATERIAL: {�_, ,1_ , <br /> /Je:�ypYl <br /> PRODUCT: <br /> A I <br /> P N <br /> P ) ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE R T WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> 0 1 <br /> V A <br /> E L <br /> D S <br /> DATE ITEM OR EQUIPMENT INSPECTED <br /> 1. UST PLANS SUBMITTED/ FEES PAID <br /> (H+S CODE 25287) <br /> 7 2. UST iNSTAILATfON PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> I= ' 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: G NRS/ IN: [. O BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: NRS/MIN: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) .S PJJ —40 NM (CCR 2636 (U) <br /> L_1I 7. SECONDARY PIPING CONTAINMENT TEST PSI./0.S`HRS/MIN:Jt U OTHER: (CCR 2636 (e)) <br /> _4 ✓ 4 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) NRS: (CCR 2635 (a) (4)) <br /> ✓ 23. 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> D 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> a' a'111 1. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> a_ �_ ✓ 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> 13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> IM 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (B)) <br /> 1 445 17. BALL FLOAT VALVES INSTALLED <br /> q lop, 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> 20. TANK INTEGRITY TEST (PASSING HARD COPY) (LCR 2635 (a) (5)) <br /> 21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK 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 /> COMMENTS: <br /> EH23-006 7/97 <br /> 10 <br />