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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME:-I,(( ADDRESS: <br /> PR# T4K# UL# zbsI g TANK MODEUMATERIAL:PUlIff <br /> ,3--rpt <br /> COMPARTMENTALIZED TANK? (If yes, complete one form for each tank) ❑ YES X,NO <br /> TANK CAPACITY: PRODUCT: <br /> DATE A INITIALS <br /> P <br /> P <br /> R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> SPECIFICATIONS <br /> c <br /> D <br /> UST PLANS SUBMITTED AND FEES PAID (H&S CODE SECTION 25287 <br /> 2. UST INSTALLATION PLANS APROVED <br /> INITIAL INSPECTIONS <br /> 3. INSP CTION AND I"EST OF SECONDARY CONTAINMENT: HOLIDAY TEST: VACUUM: <br /> 2 OV, 40 SOAP: PSI: HRS/MIN 1M)1 BRINE LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: 15i [!�ST bib Atm . <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL API/PEI <br /> d <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) Sp i?51 (CCR 2636(e)1 <br /> 7. SECONDARY PIPING CONTAINMENT TEST: PSI: HRS/M N: OTHER: fCCR 2636 e <br /> LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: CCR 2635 a` 4 ]VDCsr <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10. OVERSPILL PERFORMANCE TEST CCR 2635 b 1 C 1 <br /> 11.ALL PIPING AND FITTINGS CORROSION PROTECTED CCR 2636(b, <br /> 12. PIPING SLOPES TO COLLECTION SUMP CCR 2636 c 1 <br /> FINAL INSPECTION <br /> V, 5ft 13. PERFORMANCE TEST FOR"ALL" MONITORING PROBES CCR 2632 c 2 <br /> O 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM CCR 2632 c 2 <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION CCR 2643 c 1 <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF CCR 2636 <br /> 18. OVERFILL PROTECTION INSTALLED AND APPROVED CCR 2635 b 2 <br /> 19. TANK ACCESS PORTS BROUGHT TO GRADE LOCKED AND WATERTIGHT API <br /> 20. TANK INTEGRITY TEST PERFORMED HARD COPY SUBMITTED)':W C R 263 a 5 <br /> 21. MONITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE CCR 2632 d <br /> 22."C"FORM COMPLETED AND SUBMITTED CCR 2635' d <br /> d 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED fCCR 2630-2636 <br /> 24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H&S CODE 25284 <br /> COMMENTS <br /> EH23 006 3/18/02 <br /> 10 <br />