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NEW UST- INSTALLATION INSPECTION RECORD <br />ldmftAft <br />FACILITY'NAME: ANASTASIO' S AM MINI MAR2 3425 -TracvWBlvd,Trac <br />mzpw 71-6 TANCAI UL! ? TAMC MODELJMIITERIAL: <br />CAPACITY: t 10, 000 Gal PRODUCT: Reg Unl Gasoline #2 R.E.H.S: <br />INITIAL INSPECTIONS <br />A <br />P <br />I <br />M <br />ALL TANGS TO BE INSTALLED AID TESTED IM ACCORDANCE <br />VACUUM: I a SOAP: PSI: �. <br />P <br />I <br />WITH MAMUFACIIRER WRITTEN SPECIFICATIONS <br />i. PRIMARY TAMC TEST: PSI: HRS/MIM: <br />R <br />T <br />S. TAMC APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 CA) (3) CO (6)/ API/PEI) <br />8. <br />0 <br />I <br />-� <br />1/ <br />V <br />A <br />CCCR 205) <br />i - <br />E <br />L <br />OVERSPILL PERFORMANCE TEST <br />CCCR 2635 (A) (4)) <br />D <br />S <br />11. <br />ALL PIPING AID FITTINGS CORROSION PROTECTED <br />(CCR 2635 (B)) <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />ITEM OR EWIPMEMT INSPECTED <br />DATE <br />20. <br />NOIIITORIMG PLAN; RESPONSE PLAN ARD LOG BOOK ON SITE <br />CCCR 2632 (E) C1) (2)) .. <br />d _�S <br />21. <br />S <br />1. UST PLANS SUBMITTED/ FEES PAID (N+S CODE 25287, CCR 2635 (D) (8) <br />./ ? <br />06J2. <br />NOMITORING METHOD FOR ALL TAXIS AND PIPING APPROVED <br />UST INSTALLATION PLANS APPROVED CCCR 2635 CE) (5)) <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />=3. <br />INSPECTION AID TEST OF SECONDARY CDRAIMIRNT: HOLIDAY: <br />VACUUM: I a SOAP: PSI: �. <br />BRS/NIM: 21 Z BRIME(LIaJID ANNULAR): c "OSTHER: <br />-2 3 <br />T. <br />i. PRIMARY TAMC TEST: PSI: HRS/MIM: <br />7-25-91 <br />00 <br />S. TAMC APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 CA) (3) CO (6)/ API/PEI) <br />PIPING INSPECTIONS <br />,• FINAL INSPECTION <br />PERFORMANCE TEST FOR `ALL• MONITORING PROBES <br />PRINARY PIPING TEST (NININUM 40 PSI13O NIM) <br />cem 2635 (B) c4)) <br />-t -q3 <br />PERFORMANCE TEST OF CONTIM US MONITORING STS1 (PANEL) <br />T. <br />SECONDARY PIPING CDMTAIJM EMT TEST PSI: /NIN: b OTNER: <br />(CCR 2635 (A) CO) <br />g <br />y <br />8. <br />LAKE TEST ON ALL SM (24 HR. NIMINUN) MRS: <br />CCCR 2635 (A)) <br />-� <br />1/ <br />9. <br />UNUSED TANK OPENINGS SEALED AMD CORROSION PROTECTED <br />CCCR 205) <br />i - <br />/! <br />10. <br />OVERSPILL PERFORMANCE TEST <br />CCCR 2635 (A) (4)) <br />pp <br />to <br />11. <br />ALL PIPING AID FITTINGS CORROSION PROTECTED <br />(CCR 2635 (B)) <br />,• FINAL INSPECTION <br />COMMENTS: <br />EH23-006 3/92 (REVISED 11\92) <br />8 <br />PERFORMANCE TEST FOR `ALL• MONITORING PROBES <br />(CCR 2632 (C) (2)) <br />13. <br />PERFORMANCE TEST OF CONTIM US MONITORING STS1 (PANEL) <br />(CCR 2632 (A) C2)) <br />_ <br />14. <br />PERFORMANCE TEST OF LIME LEAK DETECTION <br />(CCR 2632 CD) 2635 (B) (5)) <br />15. <br />PERFORMANCE TEST OF AWTOHATIC PUMP STSTEN SHUT-OFF <br />CCCR 2635 (B) C5)) <br />16. <br />BALL FLOAT VALVES INSTALLED <br />(CCR 2635 CB) C6)) <br />.� <br />17. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 2635 (E) C2)) <br />18. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCIMD AID WATERTIGHT) <br />(CCR 2631 CD) CS)) <br />oy 19. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR 2635 CA) (5)) <br />20. <br />NOIIITORIMG PLAN; RESPONSE PLAN ARD LOG BOOK ON SITE <br />CCCR 2632 (E) C1) (2)) .. <br />21. <br />a" FORM COMPLETED AID SUBMITTED <br />(CCR 2635 CE)) <br />./ ? <br />✓ <br />NOMITORING METHOD FOR ALL TAXIS AND PIPING APPROVED <br />(CCR 2641-26") <br />23. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(*+S CODE 25M CE) CF)) <br />COMMENTS: <br />EH23-006 3/92 (REVISED 11\92) <br />8 <br />