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iNEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME:°� ADDRESS: d , -B <br />FACILITY ID# TANK# UL# TANK MODEL/MATERIAL: <br />CAPACITYPRODUCT: R.E.H.S: <br />r <br />INITIAL INSPECTIONS <br />A <br />I <br />��'I�' (Q <br />✓ <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE lAl <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />_1. <br />R <br />T <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) <br />HRS: <br />0 <br />I <br />A <br />V/M16. <br />9. <br />V <br />E <br />L <br />(CCR 2636 (9)) <br />DATE <br />0 <br />S <br />ITEM OR EQUIPMENT INSPECTED r <br />lu <br />(CCR 2635 (b) (1) (C)) <br />�- <br />✓ <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />V1 <br />�:� (CCR 2636 (b)) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP:V-11 PSI:3. 5 HRS/MIN:q 5 BRINE(LIQUID ANNULAR): OTHER: <br />��'I�' (Q <br />✓ <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />i <br />® <br />V <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />II <br />1� <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN). <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR 2636 (e)) <br />® <br />I <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PS1: <br />HRS/MBH: <br />OTHER: (CCR 2636 (e)) <br />_1. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) <br />HRS: <br />(CCR 2635 (a) (4)) <br />- <br />V/M16. <br />9. <br />UNUSED TANK OPENINGS SEAL® AND CORROSION PROTECTED <br />PEI <br />(CCR 2636 (9)) <br />(® <br />OVERSPILL PERFORMANCE TEST <br />(CCR 2635 (b) (1) (C)) <br />�- <br />✓ <br />1. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />1�. _ <br />�:� (CCR 2636 (b)) <br />(CCR 2635 (b) (2)) <br />2. <br />PIPING SLOPES TO COLLECTION SUMP <br />4. <br />(CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />II <br />1� <br />s <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR 2632 (c) (2)) <br />y <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (c) (2)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION° w <br />(CCR 2643 (c) (1)) <br />_ <br />V/M16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT -04 <br />(CCR 2636 (9)) <br />(® <br />BALL FLOAT VALVES INSTALLED <br />_e <br />8. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 2635 (b) (2)) <br />4. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />0. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR 2635 (a) (5)) <br />21. <br />MONITORING PUN, RESPONSE PLAN AND•LOG BOOK ON SITE <br />(CCR 2632 (d)) <br />22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR 2635 (d)) <br />(23. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2630-2636) <br />(24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S CODE 25284) <br />COMMENTS: 6 —A2— 7 r <br />tO r � <br />EH23-406 9/95 T <br />