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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: �� 0 Z� ADDRESS: <br /> k <br /> FACILITY ID# lDn TANK" ? UL# TANK MODEL/MATERIAL: <br /> x£'� <br /> CAPACITY: I Z K J PRODUCT: V LG1 R.E.H.S: <br /> A r <br /> P N ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br /> P 1 WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 1 <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> 11. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> u 2. UST INSTALLATION PLANS APPROVED <br /> u INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> i <br /> 1 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> i <br /> 5_ PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) to Z (CCR 2636 (e)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br /> 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEi <br /> 1L'�10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) , <br /> 1� p ✓ P ;11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) U <br /> 112. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> q j 3. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> [ PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> i r ✓ �I15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> 116. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br /> (r Ii( 117. BALL FLOAT VALVES INSTALLED r <br /> If 118. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 119. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> 120. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> 121. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> r, I 122. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 123. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> 124. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23-006 9/95 <br /> 10 <br />