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NEW UST INSTALLATION INSPECTION RECORD <br />FACILI-Y NAME: (' ADDRESS: <br />FACILITY ID# ' TANK# UL# TAU MODEL/MATERIAL: <br />CAPACITY:/../2000 J- jq q, PRODUCT: R.E.H.S: <br />3. <br />A <br />I <br />HOLIDAY: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />PSI: <br />R <br />T <br />9. UNUSED TANK OPENINGS CORROSION PROTECTED P <br />E GS SEALED AND COR OSIEI <br />5. <br />0 <br />I <br />(API/PEI) <br />V <br />A <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />E <br />L <br />12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />D <br />S <br />20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />22. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPROVED <br />3. <br />INSPECTION AND TEST <br />INITIAL INSPECTIONS <br />OF SECONDARY CONTAINMENT: <br />HOLIDAY: <br />VACUUM: SOAP: <br />PSI: NRS/MIN: <br />BRINE(LIOUID ANNULAR): OTHER: <br />4. <br />PRIMARY TANK TEST: <br />PSI: <br />HRS/MIN: <br />9. UNUSED TANK OPENINGS CORROSION PROTECTED P <br />E GS SEALED AND COR OSIEI <br />5. <br />TANK APPROPRIATELY <br />PLACED WITH APPROVED BACKFILL <br />(API/PEI) <br />PIPING INSPECTIONS <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />FINAL INSPECTION <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: NRS/MIN: OTHER: (CCR 2636 (e)) <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br />9. UNUSED TANK OPENINGS CORROSION PROTECTED P <br />E GS SEALED AND COR OSIEI <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />COMMENTS:— <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 />20. 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:— <br />EH23-006 7/97 <br />10 <br />