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NEW UST , 'ISTALLATION INSPECTION REC-11) <br /> FACILITY NAME: �L GF- E ALN ADDRESS: L-,A l t? "ac.- , <br /> SWEEPS# TANK# UL#�� � t TANK MDDEL/MATERIAL: '��kr"�� <br /> CAPACITY: i G OCUC T: G _ S u 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 /> it 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> -�O ✓ 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> -4i1 Z/�',T v i 3_ INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> U VACUUM: SWAP: PSI: .'j HRSLt1IM: BRINE(LIQUID ANNULAR): OTHER: <br /> 4_ PRIMARY TANK TEST: - :� PSI: HRSMIN: � <br /> yf 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 MIM) (CCR 2635 (B) (4)) <br /> fS ✓ 7. SECONDARY PIPING CONTAINMENT TEST PSI:y HRS/MIN: OTHER: ( CR 2635 (A) (4)) <br /> y S H 8_ LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br /> 7Jam' 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 0_ OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> S��L�J ✓ ►( 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> PERFORMANCE TEST FOR •ALL• MONITORING PROBES (CCR 2632 (C) (2)) <br /> 6 S-� ✓ 3_ PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> 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 /> 6--tV/ ti, 16_ BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br /> n 7_ OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2,635 (E) (2)) <br /> 6 rI 18_ TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> 19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br /> 20_ MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br /> rf 21_ "C' FORM COMPLETED AMD SUBMITTED (CCR 2635 (E)) <br /> 22_ MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) <br /> 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br /> COMMENTS_ d�. 11 -( L�jS � l} - �r� ✓a ca� r�1�k JN <br /> fjal"*- Civ S=�j j y i <br /> EH23-006 3/92 <br />