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FACILITY NAME: h4 z�q ADDRESS: ?�v <br /> FACILITY IDS !TA* C3 UL. _/'T'/Nl MODEL/MATERIAL: <br /> CAPACITY: /O"pc7r2 PRODUCT: v R.S.H.S: <br /> A I <br /> P N ALL TANKS TO SE 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 /> D S <br /> ITEM OR ECtiIPMeIT I <br /> OATS <br /> I 1. US7 PLANS SMITTED/ FEES PAID (H+S CODE 252873 <br /> /lam y� ✓ 2• UST INSTALLATIOH PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF sEemAnY CONTAINMENT: HOLIDAY: <br /> AC,a7M. SOAP: PSI: NRS 3RINE(LIaUID ANNULAR): OTHER: <br /> //��'G � ( ✓ I is4. PRIMARY TANK TEST. PSI: NRS/MIN: A•�•mon. <br /> TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFTLL (AP UPEI) <br /> ® PIPING INSPEC.:IONS <br /> �, 3�/�7I ✓ ��'16. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) ®P5/ (CCR 2636 (e}) <br /> 7. SECIOARY PIPING CONTAINMENT TEST PSI: FHZ IN• jp OTHER: (Ctat 2636 (e)) <br /> 1� ( 8. LAKE TEST ON ALL SUMPS (24 NR. MINIMM) HRS: CCS 2635 (a) (4)) <br /> 9. LUAM TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10. WERSPILL PER TEST CCGt 2535 (h} C1) CC)) <br /> ALL PIPING AND FITTINGS CORROSION PROTECTED (ccz 2636 (h)) <br /> 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> g/ff 4 7 I I 3. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (cca 2632 (c) (2)) <br /> lq 7 I V1 4. PERFORMANCE TEST OF MNTINU(X7S MONITORING SYSTEM CPANEL) (CCR 2632 (c) (2)) <br /> _ I 15. PERFORMANCE TEST OF LINE LEAK OETECTION � � CCS 2643 Cc) (1)) <br /> ,z;r.7 ✓ I16. PERFORMANCE TEST OF AtnWATIC PUMP SYSTEM MW-OFF CCca Z636 W) <br /> V. BALL FLOAT VALVES INSTALLED <br /> vCCGt 2635 Ch} (2)) <br /> �//( 7I ✓� 18. OVERFILL PROTECTION INSTALLID/APPROVED <br /> f/ I ✓ I ( 19. TANK ACCESS PORTS 3ROUGHT TO GRADE (LOCXED AND WATERTIGHT) APt <br /> 20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> MONITORING PLAN, SE PLAN AND LOG 300K ON SITE (CCR 2632 (d)) <br /> l I I22. "C' FORM COMpL_cTED AND SUBMITTED (CCI 2635 Cd)) <br /> I / (23. MONITORING ME-1410 FOR ALL TANKS AND PIPING APPROVED (CCR 200-2636) <br /> I24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED CH+S <br /> CODE 25284) <br /> COMMENTS: <br /> Q l O �II� V / � �� �® �r�t5•o <br /> EH23-006 9/95,T ® • <br />