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REV UST INSTALLATION INSPECTION "CORD <br /> FACILITY NAME: AMADDRESS: <br /> FACILITY [Dig TANKS ULS r1 5? TANK MODEL/MATERIAL: <br /> CAPACITY: ® PRODUCT: 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 <br /> 0 I <br /> V A <br /> E L <br /> 0 S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> J ( 1. UST PLANS SUBMITTED/ FEES PAID (k+S CODE 25287) <br /> ( D 2. UST INSTALLATION PIANS APPROVED <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> ftltk4• ( SOAP: PSI: HRS/MIN: BRINE(LIQIID ANNULAR): OTHER: <br /> t4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> `r <br /> S. TANK APPROPRIATELY PLACED WITH APPROVED SAGCFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIH) (CCR 2636 (e)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI• HRS OTHER: CCCA 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 /> 16. OVERSPILL PERFORMANCE TEST (CCA 2635 (b) (1) (C)) <br /> 11. ALL PIPING AND FITTINGS axROSION PROTECTED (CCR 2636 (b)) <br /> 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> I13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> 14. PERFORMANCE TEST OF MMTINUOJS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCA 2643 (c) (1)) <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br /> 17. BALL FLOAT VALVES INSTALLED <br /> f18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 19. TANK ACCESS PMTS BROUGHT TO GRADE CLOCKED AND WATERTIGHT) API <br /> I20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> (21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCA 2632 (d)) <br /> 2Z. "C" FORM COMPLETED AND SUBMITTED CCCR WS (d)) <br /> I23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCA 2630-2636) <br /> I24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23-006 9/95 T <br />