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'EW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ' ��- �. ADDRESS: [ <br /> FACILITY ID# TANK#' UL# TANK NODEL/MATERIAL:K e,, J •3' a 7-, F� <br /> CAPACITY: PRODUCT: R.E.H.S: p ctJ 9 <br /> t G c <br /> A I <br /> P N ALL 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 /> 4 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: •� <br /> VACUUM: ;/ SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> PRIMARY TANK TEST: ,�A� U U l,l/A PSI: HRS/MIN: <br /> TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> 16. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br /> SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br /> ,/l/2' I, LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br /> �. . UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> _I <br /> IW <br /> 0. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> 13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> /,2''?II'�II 4. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> PERFORMANCE TEST OF LINE LEAK DETECTION rf ,,f Ct S, G,tfi S� (CCR 2643 (c) (1)) <br /> PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br /> 7. BALL FLOAT VALVES INSTALLED <br /> OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 3. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> Ir ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23406 9/95 T <br />