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NEW UST INgTALLATION INSPECTION RECORD <br /> rACILITY NAME: ADDRESS: Vv S <br /> SWEEPS# TANK# UL#7 �� TANK MOOEL/MIITERIAL:--/— � <br /> CAPACITY: 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 /> 0 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, CCA 2635 (D) (8) <br /> 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: HRS/MIN: BRINE(LIOUID ANNULAR): OTHER: <br /> 16 5 Y q� 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 /> I a r 6. PRIMARY PIPING TEST (MINI" 40 PSI/30 MIN) G� a�/� (CCR 2635 (B) (4)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI:4HRS/MIN:40 OTHER: (CCR 2635 (A) (4)) <br /> i <br /> a.1 7_�S/ ✓ 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br /> ^I/ 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> 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 /> 1 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-Off (CCR 2635 (B) (5)) <br /> N14 16. BALL FLOAT VALVES INSTALLED b✓F��iy��-� (CCR 2635 (B) (6)) <br /> 7] �7 9 ✓ 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 /> 4 ✓ CI 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. "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 /> COMhENTS: <br /> 7H23-006 3/92 (REVISED 11\92) <br /> s <br />