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f i NEW UST INSTALLATION RECORD <br />FACILITY NAME "DI 7EXRn <br />FACILITY ADDRESS (D-3-5 E\I Ir k Lo i I <br />SWEEPS # �5�� TANK # U.L. # PRODUCTy�l <br />DATE I APPROVED I DISAPPROVED I RENS I ITEM OR EQUIPMENT INSPECTED <br />2 1+1 1. UST INSTALLATION PLANS SUBMITTED & FEES PAID <br />7lw ICS 2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTION <br />PIPING STAGE INSPECTION <br />�3 <br />1. HOLIDAY TEST (PLASTEEL) <br />I. PRESSURE TEST (10 AND 20 PSI (FRP)J I ✓ : 5v 5 , Z '' -6 5 <br />2. AIR TESTED @ 5 PSI (FRP) <br />l / <br />`t 3 V <br />3. VISUAL INSPECTION OF 20 CONTAINMENT <br />?i q <br />% 6 <br />4. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />PIPING STAGE INSPECTION <br />�3 <br />I. PRESSURE TEST (10 AND 20 PSI (FRP)J I ✓ : 5v 5 , Z '' -6 5 <br />2. BALL FLOAT VALVES INSTALLED <br />% 6 <br />3. OVERFILL PROTECTION INSTALLED, DESCRIBE: /-0n?'/dAAI1'4� <br />4. UNUSED TANK OPENING SEALED & CATHODICALLY PROTECTED <br />3. PERFORMANCE TEST OF OVERFILL PROTECTION SYSTEM <br />S. VISUAL INSPECTION OF 20 CONTAINMENT ON PIPING <br />4. PERFORMANCE TEST OF PRODUCT LINE LEAK DETECTOR (HARD <br />6. MONITORING PORTS IN PLACE & BROUGHT TO GRADE (LOCKABLE <br />WEATHER PROOF COVERS) <br />? �{ <br />7. FILL & VENT PIPING BROUGHT TO GRADE <br />5. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM(S) ON <br />8. PRODUCT LINE LEAK DETECTOR INPLACE (HARD WIRED) <br />TANK(S) <br />9. APPROVED UST LEAK MONITORING DEVICE INSTALLED <br />6. PERMIT TO OPERATE APPLICATION COMPLETE <br />10. ALL GALVANIZED PIPING & FITTINGS PROPERLY WRAPPED <br />7. ACCEPTABLE RECORD KEEPING SYSTEM <br />11. PRESSURE DECAY TEST ON COMPLETE UST & PRODUCT DELIVERY <br />SYSTEM <br />FINAL INSPECTION <br />1. PRECISION TEST SUCCESSFULLY COMPLETED AND HARD COPIES <br />RECEIVED (NFPA 329) <br />% 6 <br />2. SPILL PROTECTION AT FILL PIPE <br />3. PERFORMANCE TEST OF OVERFILL PROTECTION SYSTEM <br />4. PERFORMANCE TEST OF PRODUCT LINE LEAK DETECTOR (HARD <br />WIRED) <br />5. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM(S) ON <br />TANK(S) <br />6. PERMIT TO OPERATE APPLICATION COMPLETE <br />7. ACCEPTABLE RECORD KEEPING SYSTEM <br />