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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ADDRESS: <br />FACILITY ID# TANK# UL# TANK MODEL/MATERIAL: <br />CAPACITY: PRODUCT: y 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 />D S <br />DATE I I I ITEM OR EQUIPMENT INSPECTED <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />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 />-L- <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />z4__v] <br />I 1 1 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />I/ <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) 7 M <br />(CCR <br />2636 <br />(e)) <br />v, <br />f <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />(CCR <br />2636 <br />(e)) <br />® <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />dtal <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />2636 <br />(g)) <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />V <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />1� l� <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />COMMENTS: VA f 110 AAA <br />EH23-006 7/97 <br />10 <br />13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />(c) (2)) <br />v, <br />f <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 />/r dl r <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) (2)) <br />(� <br />19. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />/0-v/w 9 <br />ed#O <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 SITE <br />(CCR <br />2632 <br />(d)) <br />22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR <br />2635 <br />(d)) <br />i//Y/ <br />�1 <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: VA f 110 AAA <br />EH23-006 7/97 <br />10 <br />