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NEW US JSTALLATION INSPECTION RE( 'RD <br /> FACILITY NAME: _ l ADDRESS: t S t <br /> ion- l <br /> SWEEPS# TANK# UL# TANK MODEL/MATERIAL: XEr_X ES 7,6 Ips 5 <br /> CAPACITY: 1 5 U D wl PRODUCT: R.E.H.S: <br /> A I <br /> P NALL 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 /> UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> / 12� UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> /'[7/73. C INSPECT AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUI)1: SOAP: PSI: HRS/IIIN: �RIN ( ILE QUID ANNULAR) OTHER: <br /> 12 ' V/ y 4. PRIMARY TANK TEST: PSI: y HRS/MIN: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> lZ ✓ Jy 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) �ov P5 (CCR 2635'(B) (4)) <br /> 2 Z$ } f 7. SECONDARY PIPING CONTAINMENT TEST PSI: j HRS/MIN: OTHER: (CCR 2635 (A) (4)) <br /> Z Z$�4 ✓ y 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br /> m $ c i -, 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> x/13 1 f 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> ►Z1zg/9y ,y 11. ALL PIPING AND FITTINGS CORROSION PROTECTED l4 s S (CCR 2635 (B)) <br /> f FINAL INSPECTION <br /> 12. PERFORMANCE TEST FOR -ALL' MONITORING PROBES (CCR 2632 (C) (2)) <br /> 3 S 13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> 3 14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br /> '! +3 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> 1131 C J 19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br /> i 20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br /> x <br /> S \ 21. 'C' FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br /> l l�J I�5 ✓ 22' MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 264172644) <br /> 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br /> COMMENTS: <br /> s o s-t t n -Utll <br /> EH23-006 3/92 <br />