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NEW UST l j' ALLATION INSPECTION RECORD <br /> FACILITY NAME: GUS ADDRESS: <br /> SWEEPS#,,'�eZF,/8Z� TANK# C� UL#�?C�f?7cJ TANK MODEL/MATERIAL:-4-_e <br /> CAPACITY: �diOOU PRODUCT: !�/G�G 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 /> f 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> z 9yJ 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> e/t3_ INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> E{/- 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> PRIMARY PIPING TEST (MINIMI)1 40 PSI/30 MIM) Aj (CCR 2635 (B) (4)) <br /> ( Llli� Y✓ �'� <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: ! 7 HRS/MIN: ;L" /OTHER: (CCR 2635 (A) (4)) <br /> 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br /> , I �Q 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> 211�i��tv� L� 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> 2J�(7 9 12. PERFORMANCE TEST FOR •ALL' MONITORING PROBES (CCR 2632 CC) (2)) <br /> 13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> 3 �7 4. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (8) (5)) <br /> 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (8) (5)) <br /> 16. BALL FLOAT VALVES INSTALLED dvGi�Liy ErG� L6 �kZ)LG (CCR 2635 (B) (6)) <br /> 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> (g �� 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> e/-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 /> s <br /> 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br /> COMhENTS: <br /> H23-006 3/92 (REVISED 11\92) <br /> s <br />