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IEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: 2 ADDRESS: ' 11 E y <br /> FACILITY ID# TANKS.` f UL' TANK MODEL/MATERIAL:w <br /> CAPACITY: s- PRODUCT: ULWWwCA-pff— <br /> R.E.H.S: <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 ' '1 V H <br /> � .�( Aum' <br /> V 1 Vk <br /> IVC 11 ` <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE / <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> '1 12. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> 1 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> 1 I 1 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br /> �,q,�! ✓I 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS (C5 OTHER: (CCR 2636 (e)) <br /> 5 f2q ✓ i ri 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 /> 110. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> P :11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> f 112. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> I <br /> FINAL INSPECTION <br /> b�lgGi 3. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> 031 "l ( PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> q�I !1l,I '115. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> !7 q N I I 116. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHIT-OFF OvS .-A m (CCR 2636^(g)) <br /> 117. BALL FLOAT VALVES INSTALLED NT-LA <br /> $1118. OVERFILL PROTECTION INSTALLED/APPROVED '`✓ (CCR 2635 (b) (2)) <br /> I I 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> i <br /> 20. TANK INTEGRITY TEST (PASSING HARD COPY) `- (CCR 2635 (a) (5)) <br /> � I21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> i <br /> I I 122. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> I� (j'l� 1 f 123. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> �J b ^1 124. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> Qor```r�l,'ItS: �� c- YZt -tL, -EH D <br /> EH23-006 9/95 <br /> 10 <br />