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NEW UST INSTALLATION INSPECTION RECO"r) <br /> FACILITY NAME: r ADDRESS: <br /> SWEEPS# �ie�1?��G TANK# 7 UL#3c78 TANK MOOEL/MATERIAL:'--/�'�c�1C,p.74,(K <br />'CAPACITY: iZ pvv PRODUCT: V�� R.E.H.S: <br /> A I <br /> P NALL 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 /> �f 9Jy 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> z/�7 r) ✓ 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AMD TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> I <br /> VACUUM: /,V SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINI" 40 PSI130 MIN) �� �jT t�s�/� (CCR 2635 (B) (4)) <br /> � 7. SECONDARY PIPING CONTAINMENT TEST PSi:y , HRS/MIN: OTHER: (CCR 2635 (A) (4)) <br /> 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMI>!1) HRS: (CCR 2635 (A)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 10. OVERSPILL PERFORMANCE TEST <br />�/ r ''I� ✓ �I (CCR 2635 (A) (4)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> y FINAL INSPECTION <br /> 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 /> ✓ 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 (8) (5)) <br /> /v/1 16. BALL FLOAT VALVES INSTALLED,,,,��Q�� 5Y�?� FY? `j' (G (CCR 2635 (B) (6)) <br /> _F-1 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> �7 ✓ 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> c< <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 /> 1. "C" 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 /> XWENTS: <br /> 12:'A06 3/92 (REVISED 11\92) <br /> 3 <br />