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IEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME:) ADDRESS: <br />FAC:LIT'f ID# 0 TANKx ��� � UL;* TANK MCOEL/MMATcRIAL: <br />CAPACITY: ` PRODUCT: R.E.H.S: <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: 3RINE(LICUID ANNULAR): OTHER: <br />4. PRIMARY TANK EST: PSI: HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFTLL (API/PEI) <br />PIPING INSPECTICNS <br />j� OMI. <br />1 <br />A <br />I <br />.v <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />P <br />N <br />ALL TANKS TO 3E INSTALLED AND TESTED IN ACCOtDANM <br />(CCR 26.35 (a) (4)) <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />PEI <br />R <br />T <br />CVERSPILL PERFORMANCE TEST <br />(CCR 2635 (b) (1) (C)) <br />0 <br />I <br />(CCR 2636 (b)) <br />I12. <br />V <br />A <br />19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br />E <br />L <br />20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR Z635 (a) (5)) <br />0 <br />S <br />21. MONITORING PLAN, ,RESPONSE PLAN AND LOG 300K ON SITE (CCR 263Z (d)) <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />23' MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br />I24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25234) <br />1. UST PUNS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: 3RINE(LICUID ANNULAR): OTHER: <br />4. PRIMARY TANK EST: PSI: HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFTLL (API/PEI) <br />PIPING INSPECTICNS <br />j� OMI. <br />1 <br />PRIMARY PIPING TEST (MINIMUM 4 PSI/30 MIN) <br />(CCI 2636 (e)) <br />.v <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />(CC;t 2636 (e)) <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />(CCR 26.35 (a) (4)) <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />10. <br />CVERSPILL PERFORMANCE TEST <br />(CCR 2635 (b) (1) (C)) <br />11. <br />ALL PIPING AND FITTINGS CORRCSICN PROTE= <br />(CCR 2636 (b)) <br />I12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />CCMMENTS: <br />EH23-006 9/95 7 <br />I13. PERFORMANCE TEST FOR "ALL" MONITORING PROSES (CCR 2632 (c) (2)) <br />14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br />I16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (9)) <br />17. BALL FLOAT VALVES INSTALLED <br />(18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br />20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR Z635 (a) (5)) <br />21. MONITORING PLAN, ,RESPONSE PLAN AND LOG 300K ON SITE (CCR 263Z (d)) <br />I22. "C^ FORM COMPLETED AND SUBMITTED (COR Z635 (d)) <br />23' MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br />I24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25234) <br />CCMMENTS: <br />EH23-006 9/95 7 <br />