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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY RAKE: ADDRESS:- V <br /> by �� Yv4d <br /> SLEnS�" TANKS Ult %J (-?a TAMK MCOEL/MATERIAL: <br /> CAPAC:TT: PRODUCT: p�0[ae, R.Z.H.S. <br /> A I <br /> P N ALL TANKS TO 3E INSTALLED AND TESTED IN AC:,.RDANC <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 I <br /> V A <br /> E L <br /> D S <br /> ITEM OR E=PMEMT INSPECTED <br /> DATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CII 265 (D) (8) <br /> 1 �DIy( 2. UST IMSTALLATIOM PLANS APPROVED (CCA 2635 (E) C5)) <br /> 1I INITIAL IMSnCTIOMS <br /> ( 3. INSPECTION AIRED TEST OF SECMART CONTAI1MIENT: HOLIDAT: <br /> Y�'.n VAGA)1. �I11 SGP: PSI: HRSIMTN: HRINE(LIrUID ANNULAR): OTHER: <br /> I I <br /> PRIMARY TANK TES:I.F 0 PSI: HRS/MIN: <br /> U 5. TANK APPRCPRIATELT VVVVVVPLACE) WITH APPRGVEO 3ACLFILL (CCI 2635 (A) (3) (4) (6)/ APL/PEI) <br /> PIPING INSPECTIC115 <br /> 6. PRIMARY PIPING TEST (MIMIKX AO PSI130 MIM) (CII 2535 (B) (4)) <br /> 7_ SECONDARY PIPING CCMTAIMPEBT TEST PSI: HRS/MIM: OTHER: (CCI 2535 (A) (4)) <br /> nnn ..SII 8. LAKE TEST ON ALL 51W5 (24 HR. MINIMUM) HRS. (CC2 2635 (A)) <br /> B yT 9. UNUSED TANK OPENINGS SEALED AND CRROSION PRUMCM (CGt 2535) <br /> �3 �(jq ' 0. OVERSPILL PERFORMANCE TEST Z535 (A) (4)) <br /> I11_ ALL PIPING AND FITTINGS CRROSION PROTECTED (CII 2635 (3)) <br /> FINAL INSPECTION <br /> ,{ PERFORMAMC TEST FOR -ALL' MONITORING PROBES CC= 252 (C) (2)) <br /> PERFORMANC TES OF CUTIMMS MOMITORING STSTE)1 (PAMEL) (CCI 2632 (A) (2)) <br /> 14. PERFORMANCE TES. OF LIME LEAK DETECTIONs 1 o <= am (D) 2635 (8) (5)) <br /> PERFORMANCE TEST OF AUTOATIC PL" STSTE31 SHUT-OFF (CII 2635 (3) (5)) <br /> �/ <br /> I 116. BALL FLOAT VALVES INSTALLED NU �j�Q, (CII 2635 (3) (6)) <br /> MOM M (/ & <br /> 7. OVERFILL PROTECTION INSTALLED/APPROVED (CCA 2535 (E) (2)) <br /> TANK A =S PORTS 3RQIGifT TO GRADE (LOC.c"Oi AND WTE�i7I GHAT) CCIT 7531 (D) (S)) <br /> I19. TANK INTEGRITY TEST (PASSING HARD COPY) �4A�'bt✓N.v /�O� CCC2 2635 (A) (5)) <br /> Il0 I WHIT M PLAN, RESPOMSc P AND X 3100K ON SITE (CCI 2632 (E) (1) (2)) <br /> r I 'C• FORM CYPLE—,a AND SUMMED (CO2 2635 (E)) <br /> 1. MORITCRING METHOD FOR ALL TANKS AND PIPING APPROVED C= 2641'264:) <br /> l!� U. ALL a>MITICNS MET; FACTLITT PERMIT ISSUED (:HS CEDE 25294 (E) (F)) <br /> CMENTS: <br /> EH23406 3/92 (REVISED 11\92) <br /> 3 <br />