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UST INSTALLATICH INSPECTION RECORD <br />FACILITY 4AME:�- J , ADDRESS: E-- / I(,I 1 i ` J <br />FACILITY 'D* ' ):2, t" ¢-c TANKS UL* TANK ,MDOELIMATERIAL: <br />(CAPACITY: �? re-, (-�, PRODUCT. ' . I "� l Z.Z.A.3: I <br />INITIAL INSPECTIONS <br />aZa3 <br />A <br />I <br />PRIMARY PIPING TEST (MINIMUM 40 PSI13O MIN) <br />CCm 2636 (e)) <br />? <br />N <br />ALL TANKS TC 3E INSTALLED AND -kc-STED IN AC= RDANCS <br />PRIMARY TANK TEST: PSI: ;iRS/MIN: <br />P <br />[ <br />WITH 4ANUFACTIIRE2 WRITTEN SPECIFICATIONS <br />SE=NOARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />R <br />T <br />�_� <br />✓ <br />O <br />I <br />312�i I <br />t l <br />(✓ I <br />V <br />A <br />CCS 2635 (a) (4)) <br />a <br />✓ I( <br />L <br />UNUSE TANK OPENINGS SEALED AND CORROSION PROTECTED <br />?EI <br />0 <br />S <br />OVERSPILL PERFORMA -c MST <br />tC 25.:'5 (b) (1) (C)) <br />3 Izcl <br />ITEM OR SCUIPMENT INSPECTED <br />)ATE <br />ALL PIPING AND FITTINGS =RROSICN PROTEC-.- <br /><c 2636 (b)) <br />3 <br />I ✓ I <br />T2. <br />I <br />I I. UST PUNS SUBMITTED/ FSES PAID (4-S CODE 5287) <br />CCS 2632 (d)) <br />I( <br />2. UST iNSTALLATICN PLANS APPROVED <br />INITIAL INSPECTIONS <br />aZa3 <br />1 <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HCUDAY: <br />PRIMARY PIPING TEST (MINIMUM 40 PSI13O MIN) <br />CCm 2636 (e)) <br />IIACU24: '; - SOAP: PSI: ARS/MIN: 3RINE(LICUID ANNULAR): OTHER: <br />I,� <br />V <br />PRIMARY TANK TEST: PSI: ;iRS/MIN: <br />Cut 2632 (c) (2)) <br />1 1 5. <br />TANK APPROPRIATELY PLACED WITH APPROVE 3ACKFILL (APT/PEI) <br />PIPING INSPECTIONS <br />FINAL 1NSPEC71CH <br />�[ <br />1 <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI13O MIN) <br />CCm 2636 (e)) <br />p <br />0' <br />I,� <br />PERFORMANCE TEST OF CONTINUOUS MONITORING STST84 (PANE) <br />Cut 2632 (c) (2)) <br />7. <br />SE=NOARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />(CCR 2636 (e)) <br />? <br />�_� <br />✓ <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />312�i I <br />t l <br />(✓ I <br />3. <br />LAKE TEST ON ALL SUMPS (24 :IR. MINIMUM) ���ry, 3�:�fo�`; `� HRS: <br />CCS 2635 (a) (4)) <br />a <br />✓ I( <br />9. <br />UNUSE TANK OPENINGS SEALED AND CORROSION PROTECTED <br />?EI <br />f <br />( I <br />OVERSPILL PERFORMA -c MST <br />tC 25.:'5 (b) (1) (C)) <br />3 Izcl <br />I ✓ 1 <br />1. <br />ALL PIPING AND FITTINGS =RROSICN PROTEC-.- <br /><c 2636 (b)) <br />3 <br />I ✓ I <br />T2. <br />PIPING SLOPES TO COL.LC'1ION SUMP <br />CCS 2536 (c)(1)) <br />FINAL 1NSPEC71CH <br />�[ <br />1 <br />PERFORMANCE TEST FOR "ALL" MONITORING PRC8ES <br />(CCR 2532 (c) (2)) <br />p <br />0' <br />I,� <br />PERFORMANCE TEST OF CONTINUOUS MONITORING STST84 (PANE) <br />Cut 2632 (c) (2)) <br />I ✓ <br />PERFORMANCE i EST CF LINE LEAK OETECA ION #Vo. -',0 hggp <br />5 ; t CT 1643 CcJ ( 1) ) <br />�_� <br />✓ <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />7-57q, rZ 26.36 (4)) <br />17. <br />3ALL FLOAT VALVES INSTALLED Sh v j <br />'TANK <br />OVERFILL PROTECTICH INSTALLED/APPROVED <br />CC:.2 2635 (b) (2)) <br />T -L . <br />O GE (LOG.' AND WATERTIGHT) <br />ACCESS PORTS 3ROOGHT TXC <br />APT <br />l <br />✓I2e5ATANK <br />INTEGRITY TEST (PASSING HARD CPY) <br />(CCR 2635 (a) (5)) <br />U/ <br />MONITCRING PUN, RESAONSE PUN AND BOOK ONI SI <br />CCS 2632 (d)) <br />_3 <br />"C` FORM =14PLE-10 AND SUBMITTED <br />tC w 2535 (d) ) <br />123. <br />MONITCRING ME -14W FOR ALL TANKS AND PIPING APPROVED <br />CCS 253D-Zb36) <br />1 1 <br />124. <br />ALL ....NOITIONS :ET; FAC:LITY PERMIT ISSUED <br />CH+S =6 2rSzw-) <br />C. V4MENTS: <br />=-H23-JG6 9/95 7 0 0 <br />