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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME:. ,( ' Z?� go g4ADDRESS: <br /> PR# TANK# UL# Z�Sr♦ TANK MODEUMATERIAL:�vV�'� A2 <br /> A <br /> COMPARTMENTALIZED TANK? (If yes, complete one form for each tank) ❑YES ANO <br /> TANK CAPACITY: G 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 /> E <br /> D <br /> 1. -UST PLANS SUBMITTED AND FEES PAID (H&S CODE SECTION 25287 <br /> 2. UST INSTALLATION PLANS APROVED <br /> INITIAL INSPECTIONS <br /> J 3. INSPECTION AND TEST OF SECOND RYS,-ONTAINMENT: HOLIDAY TEST: VACUUM: <br /> SOAP: Cv.1 PSI: HRS/MIN 1tbRINE LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL API/PEI <br /> PIPING INSPECTIONS <br /> PRIMARY PIPING TEST MINIMUM 40 PSI/30 MIN CCR 2636 e <br /> ✓ 7. SECONDARY PIPING CONTAINMENT TEST: PSI: HRS/MIN: OTHER: ICCR 2636 e <br /> V 8. LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: CCR 2635(a <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI 5 <br /> 10. OVERSPILL PERFORMANCE TEST CCR 2635 b 1 C <br /> f1. ALL PIPING AND FITTINGS CORROSION PROTECTED CCR 2636 b <br /> ✓ <br /> T12. PIPING SLOPES TO COLLECTION SUMP CCR 2636 c 1 <br /> FINAL INSPECTION <br /> 13. PERFORMANCE TEST FOR"ALL" MONITORING PROBES FCCR 2632 c 2 <br /> 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM CCR 2632 c 2 <br /> Ov Sit 15. PERFORMANCE TEST OF LINE LEAK DETECTION CCR 2643 c 1 <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF CCR 2636 <br /> l b 18. OVERFILL PROTECTION INSTALLED AND APPROVED fCCR 2635 b 2 <br /> 19. TANK ACCESS PORTS BROUGHT TO GRADE LOCKED AND WATERTIGHT API <br /> dv 20. TANK INTEGRITY TEST PERFORMED HARD COPY SUBMITTED CCR 2635 a 5 <br /> 21. MONITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE CCR 2632 d <br /> 22."C"FORM COMPLETED AND SUBMITTED FCCR 2635'(d)] <br /> 0 V 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED CCR 2630-2636 <br /> 24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED [H&S CODE 25284 <br /> COMMENTS <br /> EH23 006 3118102 <br /> 10 <br />