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NEW UST INSTALLATION INSPECTION RECORD • <br /> FACILITY NAME: C ADDRESS: /�/ S� S" <br /> FACILITY ID# �- RANK}! /59 112 _ UL.t TANK MODEL/MATER. IAL: \J <br /> CAPACITY: C�Q PRODUCT: R_E.4.S: <br /> A I <br /> P N ALL TANKS TO 3E 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 5 <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> 1. UST PUNS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACIARM: SCAPI PSI: HRS/MIH: 3RINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: NRS/MIN: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACKFILL (API/PEI) <br /> PIPING INSPECIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIM: OTHER: (CCR 2636 (e)) <br /> 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CGT 2635 (a) (4)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10. GVERSPILL PERFORMANCE TEST (CCA 2635 (b) Cl) (C)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> I12_ PIPING SLOPES TO OXLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL iNSPECTION <br /> 13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> II 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (= 2632 (c) (2)) <br /> 5. PERFORMANCE TEST OF LINE LEAK DETECTION ,G. tZJL_, (OCR 2643 (c) (1)) <br /> !/ I I16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (9)) <br /> 17. BALL FLOAT VALVES INSTALLED <br /> 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 19. TANK ACCEE-SS PORTS BROUGHT TO GRADE (LOCXED AND WATERTIGHT) API <br /> 20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> I21. MONITORING PIAN, RESPONSE PLAN AND LOG 300K ON SITE (CCR 2632 (d)) <br /> 22. "C^ FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> 24. ALL CCNOITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: ('0'140,NLP? <br /> E423-006 9/95 T <br />