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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: /349 �, "Airil <br /> 7-6leve o S�c,a� Zz37-/9G74, M,4ry�er,4 (00 . <br /> PR# TANK# 12 UL# TANK MODEL/MATERIALXe,i)-'Xe5 cc17"- <br /> 1'i bre �•4 55 <br /> COMPARTMENTALIZED TANK? (If yes, complete one form for each tank) YES NO <br /> TANK CAPACITY: /O,ovo PRODUCT: <br /> � coo <br /> DATE A INITIALS <br /> P <br /> P <br /> R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> v SPECIFICATIONS <br /> E <br /> D <br /> 1. LIST PLANS SUBMITTED AND FEES PAID (H&,-;CQDF:SP:QTION 25287) <br /> 2. UST INSTALLATION PLANS APROVFD <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY TEST: VACUUM: SOAP: <br /> PRI. HRS/MIN7 BRINE(LIOLJIDANNULAR)- OTHER- <br /> 4. PRIMARY TANK TEST <br /> 5- TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (APIIPEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST(MINIMUM 40 PS1130 MIN) [CCR 2636(e)l <br /> 8- LAKE TEST ON ALL SUMPS(24 HR MINIMUM) HRS- rCCR 2635(a)(4)1 <br /> 9- UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 12,PIPING SLOPES TO MI I FrTION SUMP rCCR 2636(c)(1)1 <br /> FINAL INSPECTION <br /> 13- PERFORMANCE TEST FOR"ALL"MONITORING PROBES I'COR 2632(c)(2)1 <br /> 14PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM rCCR 263�(cj(��j <br /> 15, PFRFORMANCF TFST OF LINE LEAK DETECTION [CCR 264.';(c)(1)l <br /> 16- PFRFORMANCF-TEST OF AUTOMATIC,PUMP SYSTEM SHUT OFF [CCR 2636(g)l <br /> 17 RAI I FLOAT VALVES INSTALLED <br /> 18- OVERFILL PROTECTION INSTALLF-D AND APPROVED I`CCR 2635(b)(2)1 <br /> 19, TANK ACCFSS PORTS BROUGHT TO GRADF(LOCKED AND WATERTIGHT) AR <br /> 20 TANK INTEGRITY TEST PERFORMED(HARD COPY SUBMIT-FED) [CCR 2635(a)(5)1 <br /> 21, MONITORING PLAN RFSPONSF PLAN.AND LOG BOOK ON SITE rCCR 2632(d)l <br /> 22 "C"FORM COMPLETED AND SUBMITTED [CCR 2635(d)] <br /> 21. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED [COE 2630-26-461 <br /> 24, ALL CONDITIONS MET-FACILITY PERMIT ISSUED (H&S CODE 252R4) <br /> COMMENTS <br /> EH23 006 3/15/02 <br /> 10 <br />