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NEW UST 'NSTALLATION INSPECTION RECD xFt -4(-)-:((,, <br /> FACILITY NAME: � ADDRESS: > <br /> t'C- l <br /> �( -l�=V �:ti <br /> L- <br /> SWEEPS# TANK# UL# ( c�(-� TAMC MODEL/MATERIAL: X may\ <br /> CAPACITY: (2 CVV PRODUCT: 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 I <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> ��� ✓ 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> ��0 g ✓ 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:/iZ' HRSefto (� BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: ?: ,li^ PSI: _ HRS/JMI�1 <br /> �j 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL` (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> ✓ r1 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIM) (CCR 2635 (B) (4)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN:150OTHER:6 ID CCR 2635 (A) (4)) <br /> 7 J S- ✓ Hw 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) I HRS: (CCR 2635 (A)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 6 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> lz- g3" ✓ 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> 6 tJ 12. PERFORMANCE TEST FOR 'ALLN MONITORING PROBES (CCR 2632 (C) (2)) <br /> b -157113. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> tl �� 14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> E) 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br /> 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> �C <br /> 6,P S 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 /> 21. 'Co FORM COMPLETED AND 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 "/L�Si Z u +� iJZn A�/l Y (�rSu� �-d� D.n SCY-�!J Z 9L�ntiu- <br /> �/ �ol� .a,s�— ti <br /> EH23--006 3/92 <br />