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NEW UST INSTALLATION INSPECTION RECORD <br /> Adlk <br /> FACILITY NAME: Vr-1/ ADDRESS-. 3 10 <br /> [� <br /> SWEEPS# Z3 7 Zc� TANKS 0' UL# TANK MCDEL/MATERIAL: <br /> CAPACITY: 2,660 PRODUCT: U L r R.E.H.S: �. <br /> A I <br /> P N ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> O 1 <br /> V A <br /> D s /11i'T�I/47�a' L3/✓�ld�c/ S�aL� I `�'S'vM� �O/o�bc s� /-' IO�C7 - Z 'F' <br /> ✓Icon (•a/L6®�CI <br /> / ITEM OR EQUIPMENT INSPECTED <br /> OATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H+S CGDE 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 /> VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRSMIH: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCA 2635 (B) (4)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRSM)N: OTHER: (CCR 2635 (A) (4)) <br /> 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMI)) HRS: (CCR 2635 (A)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> 11_ ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> PERFORMANCE TEST FOR 'ALL' MONITORING PROBES4 <br /> e�M4c nV L� � CCR 2632 (C) (2)) I <br /> PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) „ 0 5 )Ogg 2632 (A) (2)) <br /> PERFORMANCE TEST OF LINE LEAK DETECTION i1300- (CCR 2632 (D) 2635 (B) (5)) <br /> . I r✓ )� <br /> �7'�_ ✓ 5. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> P 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br /> x/13 17 OVERFILL PRO iECTION INSTALLED/APPROVED r Q CO Z- I Z (CCR 2635 (E) (2)) <br /> 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> 19. TANK INTEGRITY TEST (PASSING HARD COPY) (LCR 2635 (A) (5)) <br /> 20 MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br /> 21. 'C• FORM COLLETED AND SUBMITTED (CCR 2635 (E)) <br /> MONITORING METHOD FOR ALL TANKS AMR) PIPING APPROVED (CCR 2641-2644) <br /> 23 ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25264 (E) (F)) <br /> COMMENTS: <br /> v q0 c� <br /> EH23-006 3/92 �Qa I rc —�GfS Z✓� (1✓�n s'�d�' Q 2`� �� <br />