Laserfiche WebLink
NEW US- INSTALLATION INSPECTION REr-%RD <br /> FACILITY NAME: o� ADDRESS: 3 t S ;71 \A�q G r\ou <br /> SWEEPS# TANK# UL# TAMC MODEL/MATERIAL: x F <br /> CJ"k.GS L rr_ Is <br /> CAPACITY: U V U PRODUCT: c C.SO���R� R.E.H.S: <br /> A I <br /> P MALL TANKS TO BE INSTALLED IUD TESTED IM ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> RT <br /> 0 I <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> i 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> vi 3_ INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIM: CBRIME(LIQUID ANNULAR OTHER: <br /> ✓ / 4. PRIMARY TANK TEST: PSI: /4 HRS/MIM: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIM) (CCR 2635 (B) (4)) <br /> ✓ 7. SECONDARY PIPING CONTAINMENT TEST PSI:('D HRS/MIM: OTHER: (CCR 2635 (A) (4)) <br /> z ✓ 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br /> UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> 3 ((Q �J 10_ OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED �_ cJ (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 LIME 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 /> i 13 QS _'� 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> l3 �,j ✓ 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> 3�G 19_ 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 /> ILlS 21. •C' FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br /> /`3 J ✓ J22_ 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 /> COMMENTS- /�l O r+v cy-yxy1'-f � Y1� dcst 4 rl aTd rClMruwt <br /> EH23-006 3/92 <br />