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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: 1[3 YojLvJ AVS <br /> PR #Fr ()t fj�I�1)�I TANK# d��%-1-1 {UL# TANK MODEL/MATERIAL: �` S <br /> COMPARTMENTALIZED TANK? (If yes, omplete one form for each tank) GY NO <br /> re+�, <br /> TANK CAPACITY: IU K PRODUCT: Dl�zc�l <br /> DATE A INITIALS <br /> P <br /> P <br /> R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> v SPECIFICATIONS <br /> E <br /> D <br /> vb1. LIST PLANS SUBMITTED AND FEES PAID (H&S CODE SECTION 25287) <br /> 2. LIST INSTALLATION PLANS APROVFn <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECON Y.CONTAINMENT: HOLIDAY TEST: VACUUM: O <br /> DMA 4. PRIMARY TANK TESL w-7T <br /> x <br /> Mak5. TANK APPROPRIATELY PLACFD WITH APPROVED BAC,'KFII-L <br /> L'o OKL44CAta.Kk Act ►�G1 z wc� <br /> PIPING INSPECTIONS <br /> 0�3x6 PRIMARY PIPING TEST(MINIMUM 40 PSI/30 MIN) fCCR 2636(e)l <br /> 1�3•y, 67 SECONDARY PIPING CONTAINMENT TESL 5 �3V OTHER- [CCR 2636(e)l <br /> Kqfo38. LAKE TEST ON ALL SUMPS (24 HE MINIMUM) HR&:!!�-qll- [CCR2635(a)(4)] <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 11 ALL PIPING AND FITTINGS CORROSION PROTECTED I`CCR 2636(b)]K 12 PIPING S LOPES To cni I F( TIQN SUMP fCCR 2636(c)(1)) <br /> FINAL INSPECTION <br /> 14, PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM FCCR 2632(c)(2)1 <br /> a� 313, PE FORMANCE TEST FOR"ALL"MONITORING PRORFS [CCR 2632(c)(2�--- <br /> 15, PERFORMANCE TEST OF LINE LEAK DFTFCTION ICCR 2643(c)(1)1 <br /> DMA, 16, PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF fCCR 2636(u)l <br /> 1 17, BALL FLOAT VALVES INSTALLED <br /> VMP, 18, OVFRFILL PROTECTION INSTALLED AND APPROVED ICCR 2635(b)(2)1 <br /> ►2 3 <br /> l�►`6�3 <br /> X IMA 19, TANK ACCESS PORTS BROUGHT TO GRADE(LOCKED AND WATERTIGHT) API <br /> x 20 TANK INTEGRITY TEST PERFORMED(HARD COPY S BMITTED) ICCE 2635(a)(5)1 <br /> 21, MONITORING PLAN. RESPONSE PLAN,AND LOG BOOK ON SITE [CCR 2632(d)l22,"C"FORM COMPLETED AND SUBMITTED ICCR 2635 (d)l <br /> 23, MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED [CCR 2630-26361 <br /> 24, ALL CONDITIONS MET� FACILITY PERMIT ISSUED (H&S CODE 25284) <br /> 3 <br /> COMMENTS _ <br /> EH23 006 3/15/02 <br /> 10 <br />