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NEW UST .2WLLATION INSPECTION RECQ <br />FACILITY NAME: �•CV rn�+ ADDRESS. 1107- S. M ° : ^ M -- f ec r <br />SWEEPS# Q S �l <br />TANK# © 3 UL# 4;5153 TANK MMEL111ATERIAL: <br />CAPACITY: L coo PRODUCT: l7 L R.E.H.S: G �, <br />INITIAL INSPECTIONS <br />2 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />R VACUUM: SOAP: L,, --PSI: 5- HRS/MIN:* <br />✓ 4. PRIMARY TANK TEST: PSI: <br />30_ I/ S. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />PIPING INSPECTIONS <br />HOLIDAY: <br />,3RINE(LIQUID ANNULAR): OTHER: <br />O HRS/MIN: <br />(CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />-� 5-53 <br />A <br />I <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (8) (4)) <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />,�a�j <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />t� <br />R <br />T <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br />0 <br />I <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br />Zri_`13 <br />V <br />A <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (8)) <br />E <br />L <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br />t, <br />D <br />S <br />19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br />ti <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />ILI21. <br />"C" FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />s <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br />✓ <br />2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />INITIAL INSPECTIONS <br />2 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />R VACUUM: SOAP: L,, --PSI: 5- HRS/MIN:* <br />✓ 4. PRIMARY TANK TEST: PSI: <br />30_ I/ S. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />PIPING INSPECTIONS <br />HOLIDAY: <br />,3RINE(LIQUID ANNULAR): OTHER: <br />O HRS/MIN: <br />(CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />-� 5-53 <br />% <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (8) (4)) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: S HRS/NIM.--50 OTHER: (CCR 2635 (A) (4)) <br />,�a�j <br />✓ <br />4118. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: ^L (CCR 2635 (A)) <br />t� <br />! <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br />Zri_`13 <br />i <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (8)) <br />FINAL INSPECTION <br />CCMMENTS <br />EH23-006 3/92 <br />12. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (C) (2)) <br />13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br />�• <br />14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br />t� <br />! <br />15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (8) (5)) <br />16. BALL FLOAT VALVES INSTALLED (CCR 2635 (8) (6)) <br />r• <br />r <br />17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br />t, <br />19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br />ti <br />20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br />ILI21. <br />"C" FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />s <br />22. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) <br />23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br />CCMMENTS <br />EH23-006 3/92 <br />