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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ADDRESS: <br />i -D <br />FACILITY ID# TANK# UL# TANK MODEL/MATERIAL: <br />CAPACITY: PRODUCT: R.E.H.S: <br />�'Gyj (LJ INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />I/ VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />4. PRIMARY TANK TEST: PSI: NRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />A <br />I <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />/J <br />P <br />0 <br />I <br />1 <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />®v�(TT�iI f�P�t&w44vo /jqw, <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />E <br />L <br />- f S"7 r.G y� yyJ 1 �lll <br />YZA <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />(CCR <br />2635 <br />(a) (4)) <br />F,X/ N <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />2636 <br />2. UST INSTALLATION PLANS APPROVED <br />�'Gyj (LJ INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />I/ VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />4. PRIMARY TANK TEST: PSI: NRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />0 <br />FINAL INSPECTION <br />14 <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />(CCR <br />2636 <br />(e)) <br />/J <br />ji <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />(CCR <br />2636 <br />(e)) <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) Sh4 ,oa l HRS G <br />(CCR <br />2635 <br />(a) (4)) <br />F,X/ N <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />2636 <br />(g)) <br />I7 <br />JJ <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />® <br />V1 <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />1 f I%7 <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />0 <br />FINAL INSPECTION <br />COMMENTS:- <br />EH23-006 7/97 <br />10 <br />14 <br />13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />(c) (2)) <br />ji <br />14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />2632 <br />(c) (2)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR <br />2643 <br />(c) (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 />® <br />V1 <br />18. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) (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) (5)) <br />21. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITEX <br />/ <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 />'" <br />24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S <br />CODE <br />25284) <br />COMMENTS:- <br />EH23-006 7/97 <br />10 <br />