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NEW UST ' JSTALLATION INSPECTION RE D <br /> FACILITY NAME: �� ADDRESS: LL>�1�' 1 � »��� ���` _ �Gi� <br /> SWEEPS# TANK# ULAi3. TANK MODEL/MATERIAL: •� � <br /> CAPACITY: PRODUCT: L R.E.H.S: <br /> A I <br /> P M 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 ECUIPMENT INSPECTED <br /> DATE <br /> Z"a"75 �/ yt 1- UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> D 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:y 31� HRS/MIN: (p(J BRINE(LIOUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: 'E �a�i2L PSI: 3� HRS,(M`IN: <br /> (S-3c7�j ✓ 5- TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> S/c/ V1 K 6- PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (B) (4)) <br /> ol SECONDARY PIPING CONTAINMENT TEST PSI: 7 HRS/MIN: $ OTHER: CCR 2635 (A) (4)) <br /> 6-7-1S- ✓ - LAKE TEST ON ALL SUMPS (24 HR_ MINIMUM) HRS: (CCR 2635 (A)) <br /> S iz Jr V/ 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 6 V 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> S�Z <br /> 5s, y1 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> 6—�� ✓ 12. PERFORMANCE TEST FOR 'ALL' MONITORING PROBES (CCR 2632 (C) (2)) <br /> Pej ✓ H 13- PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> 6 E 14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br /> V 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> r ✓ 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AMD WATERTIGHT) (CCR 2631 (D) (5)) <br /> �W <br /> 19- TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br /> 20- MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2,632 (E) (1) (2)) <br /> 6 21. 'C' FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br /> 22- MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) <br /> L 23- ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+rS CODE 25284 (E) (F)) <br /> . <br /> COMMENTS �" 7'I2 nZ° c�f�+��✓pil�el .®cs/w A owrdAL(a fy�- • ON S' 17'`t� <br /> Ar))ca� �J rn�- ilnf++t(kA, 74 rik-!( 4 /�rn�s c� /✓+r C, eaQ f� / <br /> EH23-006 3/92 <br />