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T'. NEW US•NSTALLATION INSPECTION REORD <br /> i - ADDRESS: <br /> FACILITY MANE: CI <br /> SIEEPSd I <br /> TANK - ULl TANK MODEL/M1ITERI <br /> CAPACITY: AL• R �" L��irxi� <br /> PRODUCT. LII..P R.E.H.S: <br /> `LJ��� <br /> A I <br /> P M ALL TANKS TO BE INSTALLED AND TESTED IM 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 EQUIPMENT INSPECTED <br /> GATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (INS CODE 25287, CCR 2635 (D) (8) <br /> Z. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION ANC TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/NIM: BRIME(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/"IM- <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ APT/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSIZ30 MIN) (CCR 2635 (8) (4)) <br /> 7. SECONDARY PIPING COKTAINMENT TEST PSI: HRS/MIN: OTHER: (CII! 2635 (A) (4)) <br /> 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HAS: (CCR 2635 (A)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CRR 2635) <br /> 10. OVERSPILL PERFORMANCE TEST <br /> (CCR 2635 (A) (4)) <br /> 1 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (C62 2635 (B)) <br /> FINAL INSPECTION <br /> s/z9k OK 12. PERFORKAHCE TEST FOR -ALL- MMONITORING PROBES (CCR 2632 (C) (2)) <br /> O 13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> CA14. PERFORMANCE TEST OF LIME LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> 15. PERFORKANCE TEST OF AUTOUTIC PUP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> s 29 9>Y 1< J 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (8) (6)) <br /> OK 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> 8. TANK ACCESS PORTS BROUGHT TO GRADE (LOOKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> 19. TANK INTEG7RITY TEST (PASSING HARD COPY) (CCN 2635 (A) (5)) <br /> 20. MONITORING PLAN, RESPONSE PLAN AND LOG BOCK ON SITE (CCR 2632 (E) (1) (2)) <br /> 'C• FORM COMPLETED AMD SUBMITTED (CCR 2635 (E)) <br /> ✓� MONITORING METHOD FOR ALL TANKS AND PIPING APP g L` ZAl 'VM-a--� �C 2641-2644) <br /> ` 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED y Ly (H-S CODE 25284 (E) (F)) <br /> CONKENTS: �c) ✓Q L/�U <br /> Dual L��L � <br /> EH23-006 3/92 (REVISED 11\92) <br /> 8 <br />