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(FACILITY NAME: ®' ADDRESS: I <br />(SWEEPS# TAMK# ULA TANK TERIAL: I <br />(CAPACITY: R.E.H.S: I <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LICUID ): OTHER: <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />PIPING INSPECTIONS <br />A <br />I <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (B) (4)) <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />R <br />T <br />9. UlRZED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br />O <br />I <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) CO) <br />V <br />A <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br />E <br />L <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br />D <br />S <br />19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br />ITEM OR EQUIPMElff INSPECTED <br />DATE <br />21. "C• FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br />2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LICUID ): OTHER: <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />PIPING INSPECTIONS <br />COMMENTS: <br />EH23-006 3/92 <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2635 (B) (4)) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2635 (A) (4)) <br />8. LANG? TEST ON ALL SUMPS (24 MR. MINIMUM) HRS: (CCR 2635 (A)) <br />9. UlRZED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) CO) <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br />COMMENTS: <br />EH23-006 3/92 <br />12. PERFORMANCE TEST FOR 'ALL® MONITORING PROBES (CCR 2632 (C) (2)) <br />13. PERF CE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br />14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br />15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM MW -OFF (CCR 2635 (B) (5)) <br />16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br />17. OVERFILL PROTECTION INSTALLED/ (CCR 2635 (E) (2)) <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br />19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br />20. MONITORING PLAN, RESPONSE PLAN AND LCD BOOK ON SITE (CCR 2632 (E) (1) (2)) <br />21. "C• FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />22. MONITORING IETHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) <br />23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br />COMMENTS: <br />EH23-006 3/92 <br />