Laserfiche WebLink
NEW UST INSTALLATION INSPECTION RECORD <br />:ACIL,6TY NAME: ADDRESS: r u U <br />:AGILITY ID# TANKS ULS low <br />TANK MDDEL/MATERIAL: S �_ <br />;APACITY: PRODUCT: / R.E.H.S: <br />INITIAL INSPECTIONS <br />3 6 <br />A <br />I <br />_ <br />f <br />P <br />N <br />ALL TANKS TO 6E INSTALLED AND TESTED IN ACCORD CE <br />PRIMARY TANK TEST: PSI: 2 HRS/MIN: <br />P <br />I <br />SMITH MANUFACTURER WRITTEN SPECIFICATIONS <br />Zqo <br />R <br />T <br />,' <br />�) <br />0 <br />I <br />! <br />(Ni 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />-76 <br />I ✓ <br />120. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />�� L <br />E <br />L <br />0 <br />S <br />✓ ipq� <br />23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br />i1�6 I <br />✓ IO,,,I24. <br />ITEM OR EQUIPMENT INSPECTED 3 u SC `- <br />DATE <br />5 <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />-tq 6 <br />I ry4,' <br />2. UST INSTALLATION PIANS APPROVED <br />INITIAL INSPECTIONS <br />3 6 <br />J( 3. <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />_ <br />f <br />VACUUM :. S SOAP: PSI: HRS/MIN: 3 SRINE(LIQUID ANNULAR): OTHER: <br />1 ®CN 6 <br />( 4. <br />PRIMARY TANK TEST: PSI: 2 HRS/MIN: <br />7 <br />® <br />5. <br />TANK APPROPRIATELY PLACED SMITH APPROVED SACXFTLL (API/PEI) <br />PIPING INSPECTIONS <br />-.S & <br />IV1 <br />hlf16. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) P&' (CCR 2636 (e)) <br />_ <br />f <br />RS/ N OTHER: CCCR 2636 (e)} <br />MI 7. SECONDARY PIPING CONTAINMENT TEST PSI: r HRS/y" <br />7-j0 <br />I <br />! 8. Lmm TEST ON ALL sumps (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br />7 <br />® <br />I ✓ <br />9. UNUSED TANK OPENINGS SEALED AND ION PROTECTED PEI <br />Zqo <br />✓ <br />f441 0. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />,' <br />�) <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED CCCR 2636 (b)) <br />4 <br />! <br />(Ni 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />EN23-006 9/95 T c <br />S 0 S L 0 lx ?ted <br />L/ <br />Ip, ►13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br />0.1,E 14. PERFORMANCE. TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />���� <br />I ✓ <br />Itt,15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br />1,,, 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (8)) <br />17. BALL FLOAT VALVES INSTALLED <br />�g 6 <br />( ✓ <br />I 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />6 <br />( ✓ <br />1,.,J'9' TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) APT <br />-76 <br />I ✓ <br />120. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />�� L <br />121. MONITORING PLAN, RESPONSE PIAN AND LOG SOOC ON SITE (CCR 2632 (d)) <br />Iku422. -C- FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br />.g6 ' <br />✓ ipq� <br />23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br />i1�6 I <br />✓ IO,,,I24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br />EN23-006 9/95 T c <br />S 0 S L 0 lx ?ted <br />