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NEW UST INSTALLATION INSPECTION RECORD <br />AGILITY NAME:�C(� <br />,(�_ _. ��� <br />ADDRESS: �y L � HO -6 Yl k <br />Gu`- <br />YEEPSC <br />TANKS <br />ULI TANK MODEL/MATERIAL: <br />ALL TANKS TO BE INSTALLED AM TESTED IN ACCORDANCE <br />APACITT: \� <br />/ r- C PRODUCT. <br />R.E.N.S. <br />�QS�COkO-- <br />INITIAL INSPECTIONS <br />A <br />I <br />3. INSPECTION AMO TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VAC1Al1: SOAP: PSI: HAS/MIN: BRIME(LIOUID ANIULAR): OTHER: <br />P <br />M <br />ALL TANKS TO BE INSTALLED AM TESTED IN ACCORDANCE <br />4_ PRIMARY TANK TEST: PSI: HRS/MIM: <br />P <br />I <br />WITH MAINIFACTURER WRITTEN SPECIFICATIONS <br />5. TANK APPROPRIATELY PLACID WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />R <br />T <br />(A) (4)) <br />/Cr <br />O <br />I <br />8_ <br />LAKE TEST ON ALL SUPS (24 HR_ MINIMUM) <br />V <br />A <br />(A)) <br />V <br />E <br />L <br />9. <br />UNUSED TANK OPENINGS SEALED AMD CORROSION PROTECTED <br />D <br />S <br />Y(+ <br />10. <br />ITE( OR EQUIPMENT INSPECTED <br />DATE <br />(COR 2635 (A) (4)) <br />(� �5 <br />/ <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (0) (8) <br />(CCR 2635 <br />(B)) <br />L <br />2. LIST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />INITIAL INSPECTIONS <br />vqo, S PIPING INSPECTIONS LIL"O'a(• M(1 b94//F. T- <br />3. INSPECTION AMO TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VAC1Al1: SOAP: PSI: HAS/MIN: BRIME(LIOUID ANIULAR): OTHER: <br />(CCR 2635 <br />(B) (4)) <br />4_ PRIMARY TANK TEST: PSI: HRS/MIM: <br />✓ <br />i <br />7_ <br />5. TANK APPROPRIATELY PLACID WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />vqo, S PIPING INSPECTIONS LIL"O'a(• M(1 b94//F. T- <br />.l <br />FINAL INSPECTION <br />II �Q�QS <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />(CCR 2635 <br />(B) (4)) <br />O <br />✓ <br />i <br />7_ <br />SECONDARY PIPING CONTAINMENT TEST PSIS <br />HRsA x 5L OTHER: <br />(CCR 2635 <br />(A) (4)) <br />/Cr <br />ff <br />8_ <br />LAKE TEST ON ALL SUPS (24 HR_ MINIMUM) <br />NRS: >�/ <br />(CCR 2635 <br />(A)) <br />V <br />17. OVERFILL PROTECTION INSTALLEDAPPROVED (COR 2635 (E) (2)) <br />9. <br />UNUSED TANK OPENINGS SEALED AMD CORROSION PROTECTED <br />(CCR 2635) <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOOKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br />Y(+ <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(COR 2635 (A) (4)) <br />(� �5 <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR 2635 <br />(B)) <br />.l <br />FINAL INSPECTION <br />II �Q�QS <br />12. PF3RF06MAMCE TEST FOR -ALL- MONITORING PROBES (CCR 2632 (C) (2)) <br />13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br />//[�/Ors <br />✓ <br />14. PERFORMANCE TEST OF LINE LEN( DETECTION (CCR 2632 (D) 2635 (B) (5)) <br />��lQ/CIS <br />✓ <br />15. PERFORMANCE TEST OF AUTOMATIC PUP SYSTEM SHUT-OFF (COR 2635 (B) (5)) <br />76. BALL FLOAT VALVES INSTALLED ��O tl p•�' ,_.�(COR 2635 (B) (6)) <br />�lj4f/(�S <br />V <br />17. OVERFILL PROTECTION INSTALLEDAPPROVED (COR 2635 (E) (2)) <br />S <br />I/ <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOOKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br />Y(+ <br />19_ TANK INTEGRITY TEST (PASSING HARD copy) (COR 2635 (A) (5)) <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (COR 2632 (E) (1) (2)) <br />'C` FORM COMPLETED AND SUBMITTED (COR 26.35 (E)) <br />12. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-26") <br />�3. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (NNS CODE 25284 (E) (F)) <br />COMMENTS <br />EH23406 3/92 <br />