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NEW UST INSTALLATION INSPECTION RECORD <br />'ACILITY MANE: /1 ( ADDRESS: 37'15' I k <br />SWEEPS# CJ l^ TANK# ULO / OI 9. �I TANK NODEL/M11 R(AL: xER XF� S <br />APACITY: PRODUCT- P'\ <br />C' R_E.H-S- <br />INITIAL INSPECTIONS <br />A <br />P <br />I <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />(CCR 2635 (B) (4)) <br />3 a 4 YG <br />VI <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />�0 110 <br />v I <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />8. <br />R <br />T <br />N�-�/� <br />�9. <br />/0_ <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />O <br />( <br />L1 <br />16- <br />OVERSPILL PERFORMANCE TEST <br />(CCR 2635 (A) (4)) <br />V <br />A <br />1. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR 2635 (H)) <br />a -Q6 <br />E <br />L <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />V, <br />9. <br />D <br />S <br />0. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR 2632 TO (1) (2)) <br />ITEM OR EQUIPMENT INSPECTED <br />'pulal. <br />GATE <br />(CCR 2635 (E)) <br />/ <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2641_264.) <br />-a3 <br />1_ UST PLANS SUMMED/ FEES PAID (H -S CODE 25287, CCR 2635 (D) (8) <br />ALL COM: IDMS MET; FACILITY PERMIT ISSUED <br />(NHS CODE 25284 (E) (F)) <br />2- UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />INITIAL INSPECTIONS <br />1-I q1" / .i %/n _JPIPJl IMG IMSPECvoms. _�.'r _ %• i 1 <br />Z���� <br />✓ <br />3- INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: ✓ PSL- HRS/MIM: n BRINE(LIQUID ANNULAR): OTHER: <br />(CCR 2635 (B) (4)) <br />3 a 4 YG <br />VI <br />4_ PRIMARY TANK TEST: PSI:IM- <br />SECONDARY PIPING CONTAINMENT TEST PSI:`5 NRS/MIM: (ab OYHER: <br />(CCR 2635 (A) (4)) <br />�0 110 <br />v I <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />1-I q1" / .i %/n _JPIPJl IMG IMSPECvoms. _�.'r _ %• i 1 <br />Z���� <br />✓ <br />6- <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 NIM) O/+^ -n._ <br />(CCR 2635 (B) (4)) <br />3 a 4 YG <br />VI <br />7_ <br />SECONDARY PIPING CONTAINMENT TEST PSI:`5 NRS/MIM: (ab OYHER: <br />(CCR 2635 (A) (4)) <br />�0 110 <br />v I <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR- MINIMUM) HRS: <br />(CCR 2635 (p) <br />N�-�/� <br />�9. <br />/0_ <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />(CCR 2635) <br />-a�77 - qy <br />L1 <br />16- <br />OVERSPILL PERFORMANCE TEST <br />(CCR 2635 (A) (4)) <br />/ "� 1-�r( <br />j� <br />1. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR 2635 (H)) <br />FINAL INSPECTION <br />c,, L . 0,K 2-1-q/_ I - ",- D P_& -tom _, ,tom.. 0 <br />EH23-006 3/92 <br />12_ <br />PERFORMANCE TEST FOR -ALL- MONITORING PROBES <br />(CCR 2632 (C) (2)) <br />3 a 4 YG <br />L/ <br />3. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (A) (2)) <br />�0 110 <br />v I <br />14- <br />PERFORMANCE TEST OF LIME LEAK DETECTION <br />(CCR 2632 (D) 2635 (B) (5)) <br />15. <br />PERFORMANCE TEST OF AUTOATIC PUP SYSTEM SHUT-OFF <br />(CCR 2635 (B) (5))X <br />a � G <br />16- <br />&ILL FLOAT VALVES INSTALLED <br />(CCR 2635 (B) (b)) <br />A , 9 <br />T. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 2635 (E) (2)) <br />a -Q6 <br />✓ <br />18- <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />V, <br />9. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR 2635 (A) (5)) <br />0. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR 2632 TO (1) (2)) <br />'pulal. <br />•C• FORM COMPLETED AND SUBMITTED <br />(CCR 2635 (E)) <br />/ <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2641_264.) <br />-a3 <br />ALL COM: IDMS MET; FACILITY PERMIT ISSUED <br />(NHS CODE 25284 (E) (F)) <br />c,, L . 0,K 2-1-q/_ I - ",- D P_& -tom _, ,tom.. 0 <br />EH23-006 3/92 <br />