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DOCUMENTATION FOR ENVIRONMENTAL SYSTEM INSTALLATION MANAGEMENT GROUP YES NO N/A ❑ ❑ ❑ 1, TLS-350 system installed and located per drawings, operational and properly configured. YES NO N/A State A, B, and C forms: ❑ ❑ ❑ 2 TLS-350 modem enclosure instolled. ❑ ❑ ❑ 1. Rernoval/Replacement projects Original to local agency, copies to Environmental Consultant for closure report. ❑ ❑ ❑ 3. TLS-350 alarms have been tested and configured at their ❑ ❑ ❑ 2. New Instollotien projects: Originals to local agency, _ proper settings, copies to Environmental Management. ❑ ❑ ❑ 4. All tank manhole covers opened for inspection of tank Underground Storage Tank Monitoring Plans: equipment and sump penetrations- ❑ ❑ ❑ 1. Contact designated agent assigned by Pacific Bell ❑ ❑ ❑ 5. Construction debris has been removed and the parking area Environmental Management to prepare UST Monitoring and cleaned and repaired satisfactorily. Response Pinns, ❑ ❑ ❑ 6. Damaged landscaping elements have been replaced or Spill Prevention, Control, and Countermeasure Plans: repaired. ❑ ❑ ❑ 1, Contact designated agent assigned by Pacific Bell Environmental Management to prepare SPCC plan if required. ❑ ❑ E] 7. Standby engine hos been successfully tested after new (All above ground tanks over 660 gallon capacity, or USTs tank cut-over. with total aggregate capacity over 42,000 gallons.) ❑ ❑ ❑ 8. Air and water reels located per drawings. Tank Testing Results: ❑ ❑ ❑ 1. Provide test results to local agency and Pacific Bell ❑ ❑ ❑ 9. Seal at the dispenser mount bracket/islond interface. Environmental Management, Closure Reports ❑ ❑ ❑ 10, Observation well located per drawings. '❑ ❑ ❑ 1. Manifests and triptickets, Certificates of Destruction, Compaction reports, etc. to Environmental Consultant for inclusion in Closure Report. ❑ ❑ ❑ 11. Emergency shut-off switch located per drawings. ❑ ❑ ❑ 2. Environmental Consultant to provide and rnoil copies of the Closure report to Pacific Bell Environmental Management. ❑ ❑ ❑ 12. Commodity tags installed on fill risers. ❑ ❑ ❑ 13. Manholes properly crowned. ❑ ❑ ❑ 14. Field Inspection Final Acceptance Form signed by all parties. 5ign oe/ow to inlico(e attendance of Find Inspection; Sign ugofn to indicate FiNA[ ACCEPTANCE o/ work otter FoolInspection (either in held it no remediol work needed, or otter remedol work concluded ATTENDANCE FINAL ACCEPTANCE Forilily Engineer Focality Manager Site Monoger Project Monoger Contractor Consultant LITERATURE (To be placed in a ring binder by contractor, clearly identifying each itern. Outside cover to show job location and date as per sheet P-1 of drawing set.) A. Manufacturer's WnrrQnty, Operation Manual/Maintenance Data YES NO/A (list materials received) Y ❑ ❑ ❑ 1. Tanks E ❑ ❑ ❑ 2. Sumps ' F ❑ ❑ ❑ • 3. Sensors � ❑ ❑ ❑ 4. Piping ❑ ❑ ❑ 5. Pumps ❑ ❑ ❑ 6, Double containment piping system ,;, ❑ ❑ ❑ 7. Wells 1 j ❑ ❑ ❑ 8. Leak Detection Systems SEAL BY LOCAL ENGINEER 9. Other: '� ❑ ❑ ❑ l 91 pARcnrecTurr H. 4E9 & ggO6G1�4?0 GI INC.ES w rnuva.L caw. :sr.iM.n a wcaa non :ca-+n�a r B Permits and Agency Correspondence t .utu w urca`t uarrErr ,: w nvr un. � j cp YES NO N/A 10. Copies of signed permits (Health Care Agency, County or City (; ❑ ❑ Fire Departments and Building departments, etc. as applicable) z given to Pacific Bell Engineer _ C. Test Results ' YES NO N/A ❑ ❑ ❑ 11. Fuel tests an fuel transferred from old underground storage tank ❑ ❑ ❑ 12. Tank and Piping pressure test results NO. REVISIONS / AUTHORIZATIONS DATE BY ❑ ❑ ❑ 13. Test results sent to A.O.M.D. PROJECT + CLOSE-OUT ❑ [:] E] 14. Ail test results given to Pacific Bell Engineer SHEET D. As-Built Documentatiog DRAWINGS PREPARED FOR 0LYES NO N/A PACIFIC BELL ❑ ❑ ❑ 15, Contractor has submitted accurately marked set of as-built drawings t0 Pacific Bell Engineer. SACRAMENTO, CALIFORNIA FACUTY ADDRESS N N 907 LINCOLN ROAD a 1 STOCKTON, CALIFORNIA .L DATE: 1/22/97 DRAWN BY. KGM PROJECT ENGINEER CHECKED BY: J. McGRATH ti Z E57/ft0 N0. SHEET 7 OF 7 SHEETS 0 APPROVED DRAWING NO. Z R UE046-0001 P=7 MANAGER AWM19