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UST INSTALLATION INSPECTION REc= <br />FACILITY NAME: Oa -f F,9�,Je ADDRESS: Jr <br />FACILITY ID# TANIG4 UL*YA 3 j TANK MCOEL/MATStIAL. <br />CAPACITY:% V f 0 oo PRODUCT: R.Z.B.S: <br />A I <br />P N ALL TANKS TO 3E (NSTALLE) AMC IN AC^" DA11C <br />P I �s WITH MANUFACTURER WRITTEE-M SPECT„�TIONS <br />V A <br />E L IaJ oo4`> <br />0 S a V <br />fYNV�. <br />ITEM OR =-QUIPMelT INSPECTED <br />OATE <br />1. UST PLANS S18MITTM/ FESS PAID (H+S COE Z5287) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />o. <br />3. INSPECTION AND TEST OF SECONDARY =TAINMENT: HOLIDAY: <br /><C+ 2536 Ce)) <br />VACUUM: (S Me: PSI: HRS/MIN: 3RINE(LIGUID ANNULAR): OTHER: <br />or'�✓ <br />I 14. PRIMARY TANK iEST: PSI: HRS/MIN: <br />Sci.WARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFILL WT/PEI) <br />PIPING INSPECTIONS <br />o. <br />PRIMARY PIPING TEST (MINIMUM 4 ?SI/30 MIN) <br /><C+ 2536 Ce)) <br />7. <br />Sci.WARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />CCrt 2636 (e)) <br />I <br />8. <br />LAKE -, cS'T ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />tC 265 (a) (4-0) <br />16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CC2 2636 (g)) <br />9. <br />UNUSED TANK OPENINGS StA18 AND CRROSICN PROTECTD <br />PEI <br />10. <br />OVERSPILL P£2FORMANCE TEST <br />CCS 2635 (b) C 1 ) (C) ) <br />Mil. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />CC= 2636 (b)) <br />I12. <br />PIPING SLOPES 00 COLL iTION S1MP <br />(CCE 2636 (c)(1)) <br />FINAL iNSA£CTION <br />-cH 3-106 9/95 7 <br />I I <br />I13. PERFORMANCE TEST FOR "ALL” MONITORING PROBES tCCA 2532 (c) (2)) <br />I14. PutFORMANO.E TEST OF a:NTINUOUS MONITORING SYSTEM (PANEL) CCZ"+t 2537. (c) (2)) <br />(15. PERFORMANCE TEST OF LINE LEAK DETECTION tCCE 2543 (c) (1)) <br />16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CC2 2636 (g)) <br />I <br />I17. 3ALL FLOAT VALVES UMSTALLED <br />`18. OVERFILL PRCTEC:ICN INSTALLSWAPPROVED (CCR 2535 (b) (2)) <br />f <br />19. TANK AC= -SS PORTS 3ROUGHT TD GRADE (LOCX0 AND WATERTIGHT) APT , <br />I <br />20. TANK INTEGRITY TEST (PASSING HARD COPY) CCR 2535 (a) (5)) <br />21. MONITORING PLAN, RESPONSE PLAN AND LOG 300K ON SITE (CCT 2532 (d)) <br />ZZ. "C" FORM CMPLcTED AND SUBMITTED (CCT 2655 (d)) <br />I23. MOMI7=IHG METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2536) <br />I24. ALL CNDITIONS MET; FACILITY Pcst'MIT ISSUED (H+4 CME Z.S2N-) <br />-cH 3-106 9/95 7 <br />