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.I NEW USASTALLATION INSPECTION RE(&D <br /> FACILITY MANE: T I ADDRESS: <br /> SIEEPS9 TANK# (Hj TANK MODEL/MATERIAL: <br /> CAPACITY: ko' PRODUCT: U R.E.H.S: <br /> A I <br /> P M ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <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 EOUIPIENT INSPECTED <br /> DATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H-S CODE 25287, CCR 2635 (D) (8) <br /> 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIOUID ANNA-AR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIM: <br /> 5. TANK APPROPRIATELY PLATED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (e) (4)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2635 (A) (4)) <br /> 8. LAKE TEST ON ALL SUPS (24 HR. KIWI") HRS: (CCR 2635 (A)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> 12. PERFORMANCE TEST FOR 'ALL' MONITORING PROBES (CCR 2632 (C) (2)) <br /> 13. PERFORMANCE TEST OF CONTINUOS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> 14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> 16. BALL FLOAT VALVES INSTALLED (CCR 7635 (B) (6)) <br /> 17. OVERFILL PROTECTION IMSTALLEDAPPROVED (CCR 2635 (E) (2)) <br /> ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> JR% 19. TANK INTEGRITY TEST (PASSING HARM ROPY) (CCR 205 (A) (5)) <br /> 20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br /> 717 -T <br /> v •C' FORM COMPLETED AMD 51611TTTED CCCR 2635 (E)) <br /> MONITORING METHOD FOR ALL TANKS AND PIPING APPR G 'p <br /> yn\I 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H•S CODE 25284 (E) (F)) <br /> COMMENTS: vi <br /> EH23-006 3/92 (REVISED 11\92) <br /> 8 <br />