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�NEU UST CNSTALLATICN INSPECTION RECORD <br />FACILITY 4AME:! ,y n `)(,` r' �' ADDRESS:"' 1 -_ /�r <br />JC <br />FACILITY ID# �l ` � TANKS t� UL! TANK 4COELINATERIAL. <br />CAPACITY: 1/`) PRODUCT:'n fi` n R-E_it_S: <br />INITIAL INSPECTiCNS <br />Q <br />11 <br />A <br />I <br />OF SECONDARY CONTAINMENT: ACUDAY: <br />P <br />N <br />ALL TANKS TO 3E INSTALLED AMC ,ESTER IN ACC)RDANC <br />PRIMARY TANK TEST: <br />P <br />I <br />WITH 14ANUFACTURERZ A17l I SPECIFICATIONS <br />7. <br />R <br />T <br />1 't/A& <br />0 <br />I <br />CCCt 2635 (b) (2)) <br />3 <br />V <br />A <br />LAKE MST ON ALL SUMPS (24 AR. MINIMUM) L(� tY, 3jzL,; ; 4RS- <br />CCS 2635 (a) (4)) <br />S <br />L <br />9. <br />UNUSED TANK OPENINGS SEALED AND =RROSICN PROTECTED <br />0 <br />S <br />I V <br />I <br />OVERSPILL PERZFCRMANC icSs <br />CCS 2635 Cb) (1) (C7) <br />ITEM OR EQUIPMENT INSPECTED <br />)ATE <br />1. <br />ALL PIPING AND FITTINGS CORROSION PROTEL:M <br />(Gat 2636 (b)) <br />3 <br />I ✓ <br />( _ <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S =OF 5Z87) <br />(CCR 2636 (a)(!)) <br />2. UST INSTALLATICH PUNS APPROVED <br />INITIAL INSPECTiCNS <br />Q <br />11 <br />, ✓/ <br />INSPECTION AND TEST <br />OF SECONDARY CONTAINMENT: ACUDAY: <br />IIACU24: I MAP: <br />PSI: dRS/MIN: 3RINE(LICUID ANNULAR): OTHER: <br />�4. <br />PRIMARY TANK TEST: <br />PSI: / iRS/MIN: ; <br />5. <br />TANK APPRCPRIATELT PLACED UITH APPRCVED 3ACFILL CAPI/PEI) <br />PIPING INSPEC;ICNS <br />—, �- a,, <br />b. <br />PRIMARY PIPING TEST (MINIMUM sO PS1,/3D AIN) x •, {�; �. <br />( 'f <br />COCK 2536 (e)) <br />ice° <br />n/- <br />CCGt 202 (c) C2)) <br />CC= 264.3 Cc) (1)) <br />_ / I <br />PERFCOANC TEST OF AUTOMATIC PW SYSTEM SHUT-40FF <br />C= 2636 (g) ) <br />7. <br />SECCHDARY PIPING CONTAINMENT TEST PSI : c' 4RS/MIN: F, OTHERR: <br />CCS 2636 (e)) <br />1 't/A& <br />OVERFILL PROTECTION INSTALLM APPROVED <br />CCCt 2635 (b) (2)) <br />3 <br />I ✓ <br />a. <br />LAKE MST ON ALL SUMPS (24 AR. MINIMUM) L(� tY, 3jzL,; ; 4RS- <br />CCS 2635 (a) (4)) <br />, Z� <br />i ✓ <br />9. <br />UNUSED TANK OPENINGS SEALED AND =RROSICN PROTECTED <br />PEI <br />aG <br />/ <br />I V <br />I <br />OVERSPILL PERZFCRMANC icSs <br />CCS 2635 Cb) (1) (C7) <br />Aq <br />✓ <br />1. <br />ALL PIPING AND FITTINGS CORROSION PROTEL:M <br />(Gat 2636 (b)) <br />3 <br />I ✓ <br />( _ <br />PIPING SLOPES TC C,CU.cCTION SUMP <br />(CCR 2636 (a)(!)) <br />.'THAL iNS?ECTION <br />v <br />PERFORI MCE TEST FOR "ALL" AONITORING PRCBES <br />(CCA 2632 Cc) (2)) <br />A L,Ci I <br />LL -ZA_b� ✓ <br />PERFORMANCE TEST OF CONTINUOUS W NITORING Sl,T, (PANEL) <br />PERFORMANCE TEST OF LINE LEAK OETEMON <br />CCGt 202 (c) C2)) <br />CC= 264.3 Cc) (1)) <br />v <br />PERFCOANC TEST OF AUTOMATIC PW SYSTEM SHUT-40FF <br />C= 2636 (g) ) <br />I <br />I I17. <br />3ALL FLOAT VALVES INSTALLED <br />1 't/A& <br />OVERFILL PROTECTION INSTALLM APPROVED <br />CCCt 2635 (b) (2)) <br />1 3 <br />TANK ACCSS PORTS 3ROOGHT TD GRADE (LCC%% AND W►TERTIGRIT) <br />API <br />dL <br />TANK INTEGRITY (PASSING iIARD Y) <br />(CCR 2635 (a) (5)) <br />,a I <br />63f) <br />MONITCRIN Wi, 2ESPaNSE P 3=LAG 3ON SITE <br />"C" FORM =MPLETIED ANO SUBMITTEDCC's <br />CCS 263Z Cd) ) <br />2635 (d)) <br />I <br />W NI TORING NETTi O FOR ALL TANKS AND PIPING APPROVED C f f <br />(CM Z63O-2536) <br />ALL CiOITICNS AST; FACILITY PERMIT ISSUE? <br />(H+SE 5284) <br />C-lWMENTS: <br />INN --106 9/95 7 0 0 <br />