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NEW US- INSTALLATION INSPECTION RE `RD ` <br /> FACILITY NAME: ADDRESS: <br /> SWEEPS# TANK# UL# �i�,�•T TANK MODEL/MATERIAL: <br /> CAPACITY: V C>:�U PRODUCT: /z- _ BUJ 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 /> 0 I <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> ✓ K 1_ UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> �!D eGS� ✓ 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> 7 INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUFI: SOAP: _-- PSI: zf,,;- HRS/1111: GC,) BRINE(LIQUID ANNULAR): OTHER: <br /> z�n 4. PRIMARY TANK TEST: PSI: -4, HRS/}Illl: <br /> `, ; <br /> S S 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) (CCR 2635 (B) (4)) <br /> <�6. ✓ 7. SECONDARY PIPING CONTAINMENT TEST PSI: It <br /> HRS/MIN: 5e) OTHER:so aA CCR 2635 (A) (4)) <br /> 7 1, 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMM) NRS: (CCR 2635 (A)) <br /> Z 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> V/ ri 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2,635 (B)) <br /> FINAL INSPECTION <br /> V/ 12. PERFORMANCE TEST FOR •ALL• MONITORING PROBES (CCR 2632 (C) (2)) <br /> 13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> 4. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2.635 (B) (5)) <br /> /Y 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> VK416. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br /> 6_ v td 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> G-13 ✓ 18_ TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> 19. TANK INTEGRITY TEST (PASSING HARD COPT) (CCR 2635 (A) (5)) <br /> ✓ 20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br /> /L/I M1421. 'C• FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br /> 6_ / MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) <br /> 6 2( S f r4+_ 23. ALL CONDITIONS MET; 1FAC�ILITY PERMIT ISSUE�DB� (H+S CODE 25284 (E) (F)) <br /> COMMENTS; D, 4,-l2 r 7 o 42 6W <br /> EH23--006 3/92 <br />