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. , NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME:�' �t f ADDRESS: Q <br />SWEEPS9 -Z, !® 7Z- TANKS l uurfO TANK TERIAL: J 5 , <br />CAPACITY: /_ �}7jz� PRODUCT: n R.E.H.S: <br />INITIAL INSPECTIONS <br />A <br />I <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: W SOAP: PSI: HRS/MIN: 3C) BRIME(LIQUID ): OTHER: <br />P <br />M <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />/_ 3 f6 <br />P <br />I <br />WITH MAWFAC7UR8t WRITTEN SPECIFICATIONS <br />U <br />R <br />0 <br />T <br />I <br />9.UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br />�� <br />V <br />A <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br />6 <br />E <br />L <br />ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br />�� j 6 <br />D <br />S <br />16. <br />BALL FLOAT VALVES INSTALLED <br />(CCR 2635 (B) (6)) <br />�� �.- 6 <br />--rr <br />M <br />17. <br />OVERFILL PROTECTION INSTALLED/ <br />ITEM OR EQUIPMENT I U"� <br />DATE <br />✓ <br />18. <br />7Aj s- <br />(CCR 2631 (D) (5)) <br />4 <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br />/®_Z6.ti <br />19. <br />TAD( INTEGRITY TEST (PASSING HARD COPY) <br />2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />�! <br />(7 <br />✓ <br />r( <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: W SOAP: PSI: HRS/MIN: 3C) BRIME(LIQUID ): OTHER: <br />X23 �G <br />M <br />4. PRIMARY TANK TEST: PSI: 8RS/MIN:,3c) <br />/_ 3 f6 <br />1/ <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />PIPING INSPECTIONS <br />�! <br />(7 <br />✓ <br />t4 <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) Sl� OPS �h,f, (CCR 2635 (B) (4)) <br />��� <br />✓ <br />M <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: , W"N /MIN: b (7 OTHER.- CCCR 2635 (A) (4)) <br />_ <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br />U <br />lqt.14. <br />9.UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br />�� <br />✓ <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br />6 <br />/1,14111. <br />PERFORMANCE TEST OF AUTOMATIC PUP SYSTEM SMUT -OFF <br />ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br />FINAL ;NSPECTION <br />G <br />✓ <br />t4 <br />12. <br />PERFORMANCE TEST FOR -ALL- MONITORINGPROBES(CCR <br />2632 (C) (2)) <br />U <br />✓ev13. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (A) (2)) <br />U <br />lqt.14. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR 2632 (D) 2635 (B) (5)) <br />15. <br />PERFORMANCE TEST OF AUTOMATIC PUP SYSTEM SMUT -OFF <br />(CCR 2635 (B) (5)) <br />�� j 6 <br />✓ <br />16. <br />BALL FLOAT VALVES INSTALLED <br />(CCR 2635 (B) (6)) <br />�� �.- 6 <br />✓ <br />M <br />17. <br />OVERFILL PROTECTION INSTALLED/ <br />(CCR 2635 (E) (2)) <br />,;-zj-f 6 <br />✓ <br />18. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />4 <br />,� <br />tj <br />19. <br />TAD( INTEGRITY TEST (PASSING HARD COPY) <br />(CCR 2635 (A) (5)) <br />2- d b <br />✓ <br />M <br />20. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR 2632 (E) Cl) (2)) <br />, <br />✓ <br />JrW21. <br />-C" FORM COMPLETED AND SUBMITTED <br />(CCR 2635 (E)) <br />�-� 6 <br />22. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APP0VED <br />CCCR 2641-2644) <br />-S--2--$6 <br />✓ <br />ALL CONDITIONS MET; FACILITY PERMIT I <br />(H+S CODE 25284 (E) (F)) <br />EH23-006 3/92 <br />