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X <br />NEW USTTALLATION INSPECTION RECO <br />fj <br />FACILITY NAME: - ADDRESS: <br />LOVN <br />SLEEPS# TANKS ULA " 'jS UlD TANK MODEL/MATERIAL: <br />CAPACITY. I CXDQ PRODUCT: (tL- R.E.H.S: <br />INITIAL INSPECTIONS UL (081 R(Y) LA FD 2 -8 -F,9 -Z <br />C <br />A <br />I <br />3. INSPECTION AMD TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP. PSI: HRS/MIN: NE{LIQUID OTHER: <br />P <br />M <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />3� �SV1 <br />P <br />R <br />I <br />T <br />WITH MANUFACTURER WRITTEN SpECIFI TIONS <br />(Y <br />14. <br />0 <br />I <br />8. <br />LAKE TEST ON ALL %JiPS (24 HR. MINIMUM) HRS: <br />Y <br />A <br />`- <br />DATE <br />E <br />D <br />L <br />S <br />I <br />ITEM OR ECUIPMENT INSPECTED <br />Jv-t <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S COME 25287, CCR 2635 (D) (8) <br />OVERSPILL PERFORMANCE TEST <br />(CCR 2635 (A) (4)) <br />6 iZ-j S <br />2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />INITIAL INSPECTIONS UL (081 R(Y) LA FD 2 -8 -F,9 -Z <br />C <br />J <br />3. INSPECTION AMD TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP. PSI: HRS/MIN: NE{LIQUID OTHER: <br />9 q s <br />✓ <br />/. <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />3� �SV1 <br />7. <br />5. TANK APPROPRIATELY PLACE WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />6 -30-I <br />12. <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIM) 6 Ps / <br />(CCR 2635 (B) (4)) <br />✓ <br />t„ 13. <br />�,IL � <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />(CCR 2635 (A) (4)) <br />14. <br />I/ <br />rP <br />8. <br />LAKE TEST ON ALL %JiPS (24 HR. MINIMUM) HRS: <br />(CCR 2635 (A)) <br />G JL.s} <br />(CCR 2635 (B) (5)) <br />9. <br />UNUSED TANK OPEXIXGS SEALED AND CORROSION PROTECTED <br />(CCR 2635) <br />Jv-t <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(CCR 2635 (A) (4)) <br />6 iZ-j S <br />✓ <br />t/ 18. <br />1. <br />ALL PIPING AMD FITTINGS CORROSION PROTECTED <br />(CCR 2635 (B)) <br />FINAL INSPECTION <br />6 -30-I <br />12. <br />PERFORMANCE TEST FOR •ALL• MONITORING PROBES <br />(CCR 2632 (C) (2)) <br />6 _ <br />✓ <br />t„ 13. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (A) (2)) <br />14. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR 2632 (D) 2635 (B) (5)) <br />I <br />15. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR 2635 (B) (5)) <br />K4 16. <br />BALL FLOAT VALVES INSTALLED <br />(CCR 2635 (B) (6)) <br />17. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 2635 (E) (2)) <br />✓ <br />t/ 18. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />6 J <br />19. <br />TANK INTEGRITY TEST (PASSING HARD COPT) <br />(CCR 2635 (A) (5)) <br />20. <br />MONITORING PL4, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR 2632 (E) (1) (2)) <br />G <br />21. <br />•C' FORM CCKOLETED AND SUBMITTED <br />(CCR 2635 (E)) <br />�4 : j ; <br />22. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(C13R 2641-2644) <br />23. <br />ALL Ci7NDITIONS MET; FACILITY PERMIT ISSUED <br />(MF+S CODE 25284 (E) (F)) <br />EN23-006 3/92 (F <br />y)k-/Ytnp)� w 4 -2, -7 <br />