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/ NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: `(' Y me-r (. ! <br /> FACILITY ID# TANK# ULA TANK MODEL/MATERIAL: <br /> CAPACITY: PRODUCT: R.E.H.S: V., <br /> //��( 1-,f <br /> P N ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE �'�J' � <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T �-uq* <br /> 0 I �IP�n�J ihJ7t�11q_b In. b��i� . <br /> V A �If'j��•/�, Z <br /> E L ✓ J -IvJ �a• <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> 2- UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> 6- PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) Q (CCR 2636 (e)) <br /> B, V 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br /> 8, CJ'0 8. LAKE TEST ON ALL SUMPS (24 HR- MINIMUM) HRS: (CCR 2635 (a) (4)) <br /> g „ ob -4Q 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 7, �a� 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> s, roii. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> k4 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 /> 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 /> +g,LTG 17. BALL FLOAT VALVES INSTALLED �� - a •I1 <br /> 18. OVERFILL PROTECTION INSTALLED/APPROVED 1\ (CCR 2635 (b) (2)) <br /> 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> ,I g. 20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> 21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> i�r(7U 22. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> ot 24- ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23-006 9/95 <br /> 10 / <br />