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NEW U PrALLATION INSPECTION REClowD <br />FACILITY NAME: Vev r v ^ ADDRESS: 1 Q ?,. G� %V\ a; <br />SWEEpS# S �' TANK#rC� 1 UL#(,) e7s t 2 TANK MODEL/MATERIAL: { 0/S <br />CAPACITY: PRODUCT: OfR.E.H.S: P,_, <br />INITIAL INSPECTIONS <br />j 3o -h 2 <br />A <br />I <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: S HRS/MIN: 3 BRINE(LIQUID ANNULAR): OTHER: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />30- 92 <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />14. <br />R <br />T <br />ZG y3 <br />,% <br />0 <br />I <br />(CCR 2635 (B) (5)) <br />Z- 2�,•y� <br />V <br />A <br />BALL FLOAT VALVES INSTALLED <br />(CCR 2635 (B) (6)) <br />E <br />L <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />D <br />S <br />✓ <br />1418. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR 2635 (A) (5)) <br />�1� b-� 3 <br />✓ <br />20. <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br />L I .$ 1 <br />/ <br />tg- <br />1 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />INITIAL INSPECTIONS <br />j 3o -h 2 <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (B) (4)) <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: S HRS/MIN: 3 BRINE(LIQUID ANNULAR): OTHER: <br />_ -4Z. <br />yr <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: ��` � "ll <br />30- 92 <br />P <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />PIPING INSPECTIONS <br />p <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (B) (4)) <br />1_2 _C,3 <br />CCR 2632 (C) (2)) <br />ctn <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: �� OTHER: (CCR 2635 (A) (4)) <br />Z rl <br />✓ <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br />P <br />Z, Z(,- <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br />14. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br />ZG y3 <br />,% <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br />FINAL INSPECTION <br />/�.`,'j- I <br />12. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBE �� <br />CCR 2632 (C) (2)) <br />ctn <br />13. <br />PERFORMANCE TEST OF CONTINUOUS MONITORINGS TEM PANEL � <br />JF <br />CCR 632 (A) (2))iS <br />Z, Z(,- <br />✓/ <br />14. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR 2632 (D) 2635 (B) (5)) <br />ZG y3 <br />,% <br />Y� 15. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR 2635 (B) (5)) <br />Z- 2�,•y� <br />�/ <br />16. <br />BALL FLOAT VALVES INSTALLED <br />(CCR 2635 (B) (6)) <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 2635 (E) (2)) <br />✓ <br />1418. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />/4,19. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR 2635 (A) (5)) <br />�1� b-� 3 <br />✓ <br />20. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCP. 2632 (E) (1) (2)) <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR 2635 (E)) <br />22. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2641-2644) <br />v" <br />23. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S CODE 25284 (E) (F)) <br />COMMENTS: <br />EH23-006 3/92 <br />