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NEW USIOSTALLATION INSPECTION RE(*D kFACILITY MANE: ADDRESS PS&` TANK# ULS TANK MODEUMATERIAL: CITY: E PRODUCT: R.E.H.S A P M ALL TANKS 70 BE INSTALLED AND TESTED IM ACCORDANCE P I WITH MANUFACTURER 'MITTEN SPECIFICATIONS R T 0 I V A E L D S ITEM OR EQUIPIM_NT INSPECTED DATE 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) INITIAL INSPECTIONS 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY- VACUUM: SOAP: PSI: HRS/MIM: BRINE(LIGUID ANNULAR): OTHER: 4. PRIMARY TANK TEST: PSI: HRS/MIM: 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) PIPING INSPECTIONS 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIM) (CCR 2635 (B) (4)) 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2635 (A) (4)) 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) NRS: (CCR 2635 (A)) 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (8)) FINAL INSPECTION 12. PERFORMANCE TEST FOR 'ALL' MONITORING PROBES (CCR 2632 (C) (2)) 13. PERFORMANCE TEST OF CONTINUOUS 110NITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) 14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (8) (5)) 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2.631 (D) (5)) 19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) 20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) 21. NCO FORM CCMPLETED AND SUBMITTED (CCR 2635 (E)) 22. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) COMMENTS: EH23-006 3/92 (REVISED 11\92)