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LITY NAME:-� <br />CAPACITY: /v. & oc <br />NEW UST INSTALLATION INSPECTION <br />V I 7 ADDRESS: 4) %f <br />c'7 C�t2�'� <br />TANKS UL#6 5r 7(I5- TANK MODEL/MATERIAL: <br />PRODUCT: <br />D/L S cL R.E.N.S: <br />AI <br />A <br />I <br />- 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (B) (4)) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI-. HRS/MIN:w OTHER: (CCR 2635 (A) (4)) <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />P <br />P <br />N <br />I <br />ALL TANKS TO RE INSTALLED AND TESTED IN ACCORDANCE <br />s-�- yY <br />R <br />T <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />(/ <br />0 <br />1 <br />HRS/MIN: <br />fj -ZO H <br />V <br />A <br />TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />E <br />L <br />15. PERFORMANCE TEST OF AUTOMATIC PUP SYSTEM SHUF-OFFJ 01 (CCR 2635 (B) (5)) <br />Ly <br />D <br />S <br />16. BALL FLOAT VALVES INSTALLED <br />GATE <br />ITEM OR EQUIPMENT INSPECTED <br />9 <br />UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br />2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />AI <br />TIT3. <br />GU <br />- 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (B) (4)) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI-. HRS/MIN:w OTHER: (CCR 2635 (A) (4)) <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />HOLIDAY: <br />8. Z21Ii LAKE TEST ON ALL SUES (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br />s-�- yY <br />VACUUM: SOAP: PSI: HRS/MIN: <br />BRINE(LIQUID ANNULAR): OTHER: <br />U <br />(/ <br />t��� b. <br />PRIMARY TANK TEST: S PSI: <br />HRS/MIN: <br />fj -ZO H <br />V <br />lt" 5. <br />TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />15. PERFORMANCE TEST OF AUTOMATIC PUP SYSTEM SHUF-OFFJ 01 (CCR 2635 (B) (5)) <br />Ly <br />(CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />5.4 ��LI <br />'Z°- ( <br />y/ <br />GU <br />- 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (B) (4)) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI-. HRS/MIN:w OTHER: (CCR 2635 (A) (4)) <br />8. Z21Ii LAKE TEST ON ALL SUES (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br />s-�- yY <br />✓ <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br />fj -ZO H <br />✓ <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br />COMMENTS:— � I vi9Y C-.�-aI •T. !r 7�/i 4c �1cv <br />t>(oT" Loh�ZE'-E (F T <br />EN23-006 3/92 (REVISED 11\92) <br />8 <br />12. PERFORMANCE TEST FOR 'ALL' MONITORING PROBES (CCR 2632 (C) (2)) <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (A) (2)) <br />14. PERFORMANCE TEST OF LINE LEAK DETECTION <br />✓ d�'r/ 0 l (CCR 2632 (D) 2635 (B) (5)) <br />15. PERFORMANCE TEST OF AUTOMATIC PUP SYSTEM SHUF-OFFJ 01 (CCR 2635 (B) (5)) <br />Ly <br />16. BALL FLOAT VALVES INSTALLED <br />(CCR 2635 (B) (6)) <br />9 <br />17. OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 2635 (E) (2)) <br />G/ <br />✓ <br />EI <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />19. TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR 2635 (A) (5)) <br />G. <br />20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE ✓d"b b,Y. o - CCR 2632 (E) (1) (2)) <br />C <br />/ <br />21. •C• FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />22. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2641-2644) <br />23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S CODE 25284 (E) (F)) <br />COMMENTS:— � I vi9Y C-.�-aI •T. !r 7�/i 4c �1cv <br />t>(oT" Loh�ZE'-E (F T <br />EN23-006 3/92 (REVISED 11\92) <br />8 <br />