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NEW USI 'NSTALLATION INSPECTION REC-1RD y� �/ q <br /> FACILITY NAME: r r ADDRESS: �� t� S YU <br /> SWEEPS# TANK# .� =LTANK MODEL/MATERIAL: <br /> CAPACITY: O PRODUCT: >�. R.E.H_S: iT/'� <br /> A i <br /> P M ALL TANKS TO BE INSTALLED AID TESTED IN ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS I <br /> RT I <br /> O 1 <br /> A <br /> E <br /> E L <br /> D S ^�UQ9a <br /> ITEM OR EQUIPMENT 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 /> I VACUUM: S0AP. PSI: HRS/MIN: BRINE(LIOUID ANNULAR): OTHER: <br /> y.i3 SIJ 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> VM, 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> J <br /> PIPING INSPECTIONS <br /> �I�_ 6ZIL . PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIM) gC) Si 30 (CCR 2635 (B) (4)) <br /> / <br /> T. SECONDARY PIPING CONTAINMENT TEST PSI: 6 OTHER- (CCR 2635 (A) (4)) <br /> V�/ 8. LAKE TEST ON ALL SUPS (24 HR. MINIMUM) HRS: ZL (CCR 2635 (A)) <br /> ID I3'�IS v 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> _ 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> rV/( <br /> W-d 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> �„ ._ '� ✓ 2. PERFORMANCE TEST FOR 'ALL' MONITORING PROBES (CCR 2632 (C) (2)) <br /> / ✓ 13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> 14. PERFORMANCE TEST OF LINE LEAK DETECTION r �.'tr �(,,� C+tom (CCR 2632 (D) 2635 (B) (5)) <br /> 15. PERFORMANCE TEST OF AUTOATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br /> OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) .=: c (CCR 2631 (D) (5)) <br /> J01MI20. <br /> . TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br /> la-a8'`�5MONITORING PLAN, RESPONSE PLAN AND-1OG BDOK OY SITV (CCR 2632 (E) (1) (2)) <br /> 'C' FORM COMPLETED AND SUBMITTED (CCR 26635 (E)) <br /> ONMITORING METHOD FOR ALL TANKS AND PIPING APPROVEDTIPSis & I/'N( -2py1-2644) <br /> — _ ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br /> COMMENTS: <br /> EH23-006 3192 <br />