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NEW UST INSTALLATION INSPECTION RECORD <br />ACUITY NAME: % Ask ADDRESS: / ZJ <br />FACILITY ID# ICi TANKS UL-* C CI - �/L, TANK MODEL/MATERIAL: <br />:APACITY: /0L 002 <br />PRODUCT: N I +T R.E.H.S: <br />INITIAL INSPECTIONS <br />6 3. <br />A <br />I <br />VACUUM: ) SOAP: PSI: HRS/MIN: 3 Z 3RIHE(LIQUID ANNULAR): OTHER: <br />7 6 1 4. <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />1114-1- LAKE TEST ON ALL PS (24 HR. MINI") HRS: (CCR 2635 (a) (4)) <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />0 1� <br />R <br />T <br />7 <br />®! <br />t/11. <br />O <br />V <br />I <br />A <br />I �IY't41. <br />PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />E <br />L <br />I <br />0 <br />S <br />1 <br />w <br />ITEM OR EQUIPMENT INSPECTED <br />OATE <br />¢- <br />S R 6 <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />6 <br />✓ <br />IK2. <br />UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />6 3. <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) "7S -$l 3 7 t4X,. (CCR 2636 (e)) <br />VACUUM: ) SOAP: PSI: HRS/MIN: 3 Z 3RIHE(LIQUID ANNULAR): OTHER: <br />7 6 1 4. <br />PRIMARY TANK TEST: PSI: 13HRS/MIN: a <br />-7—Z216 <br />TANK APPROPRIATELY PLACED WITH APPROVED BACXFILL (APT/PEi) <br />PIPING INSPECTIONS <br />Z-SJ6 <br />I VI <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) "7S -$l 3 7 t4X,. (CCR 2636 (e)) <br />7q:2 <br />V1 <br />7. SECONDARY PIPING CONTAINMENT TEST PSI:' HRS/MIN:, Z OTHER: (CCA 2636 (e)) <br />-7—Z216 <br />(// <br />1114-1- LAKE TEST ON ALL PS (24 HR. MINI") HRS: (CCR 2635 (a) (4)) <br />1 <br />9. LBIUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br />0 1� <br />V <br />1 X 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />7 <br />®! <br />t/11. <br />ALL PIPING ANO FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />I �IY't41. <br />PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />v- "S-" <br />I VI <br />.,I13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCA 2632 (c) (2)) <br />�.� <br />I <br />1 <br />14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />15. PERFORMANCE TEST OF LINE LEAK OETECTION (CCA 2643 (c) (1)) <br />S <br />I <br />116. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (Q)) <br />17. BALL FLOAT VALVES INSTALLED <br />S <br />I <br />I <br />1a. OVERFILL PROTECTION INSTALLED APPROVED (CCR 2635 (b) (2)) <br />1 <br />119- TANK ACCESS PORTS SROUGHT TO GRADE (LOCKED AND WATERTIGHT) APT <br />?1,7 <br />1 <br />20. TANK INTEGRITY TEST (PASSING HARD CLAY) (CCR 2635 (a) (5)) <br />I21. MONITORING ALAN, RESPONSE PLAN AND LOG 3O0K ON SITE (CCA 2632 (d)) <br />2r, �-,� (� <br />I <br />122. <br />"G"' FORM COMPLETED AND SUBMITTED (CCR 2635 (d) ) <br />123. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (cR 2630-2636) <br />124. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br />r <br />E423-006 9/95 T <br />