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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME <br />wADDRESS: <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN), <br />v/ ' <br />f <br />FACILITY ID# <br />2636 <br />TANK# <br />UL# <br />TANK MODEL/MATERIAL: <br />CAPACITY: <br />7. <br />PRODUCT: <br />(CCR <br />R.E.H.S: <br />A <br />I <br />8. <br />P <br />N <br />ALL TANKS <br />TO BE INSTALLED AND <br />TESTED IN ACCORDANCE <br />P <br />I <br />WITH <br />MANUFACTURER WRITTEN <br />SPECIFICATIONS <br />R <br />T <br />0 <br />I <br />(CCR <br />2635 <br />(b) (1) (C)) <br />V <br />A <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />E <br />L <br />(b)) <br />D <br />S <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. 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 />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />1 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN), <br />v/ ' <br />f <br />(CCR <br />2636 <br />(e)) <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) HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />COMMENTS:— �' , i7I /'�9U/YfA` <br />EH23-006 7/97 <br />10 <br />13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br />14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br />16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br />17. BALL FLOAT VALVES INSTALLED <br />18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br />fa-�Jf <br />TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br />22. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br />23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br />24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br />COMMENTS:— �' , i7I /'�9U/YfA` <br />EH23-006 7/97 <br />10 <br />