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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ADDRESS: <br />FACILITY ID# TANK# UL# TANK.MODEL/MATERIAL: <br />'CAPACITY: PRODUCT: R.E.H.S: <br />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 />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />A <br />I <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />(2)) <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />14. <br />R <br />T <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br />(c) <br />0 <br />I <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />V <br />A <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />2643 <br />E <br />L <br />12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />D <br />S <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />2636 <br />(g)) <br />ITEM OR EQUIPMEHT INSPECTED <br />DATE <br />17. <br />BALL FLOAT VALVES INSTALLED <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. 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 />4. PRIMARY TANK TEST: PSI: HRS/MIN:. <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCA 2636 (e)) <br />(2)) <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM)- HRS: (CCR 2635 (a) (4)) <br />14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br />(c) <br />(2)) <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />2643 <br />(c) <br />(1)) <br />12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />COMMENTS:— <br />EH23-006 9/95 <br />13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />(c) <br />(2)) <br />14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />2632 <br />(c) <br />(2)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR <br />2643 <br />(c) <br />(1)) <br />16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />2636 <br />(g)) <br />17. <br />BALL FLOAT VALVES INSTALLED <br />18. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) <br />(2)) <br />19. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT). <br />API <br />20. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2635 <br />(a) <br />(5)) <br />21. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR <br />2632 <br />(d)) <br />22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR <br />2635 <br />(d)) <br />23. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR <br />2630-2636) <br />24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S <br />CODE <br />25284) <br />COMMENTS:— <br />EH23-006 9/95 <br />