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s <br />C <br />FACILITY NAME: ADDRESS: <br />PR # TANK# UL# TANK MODEUMATERIAL: <br />COMPARTMENTALIZED TANK? (If yes, complete one form for each tank) ❑ YES ❑ NO <br />TANK CAPACITY: PRODUCT: <br />DATE A INITIALS <br />P <br />R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br />° SPECIFICATIONS <br />E <br />D <br />441111[6]P <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY TEST: VACUUM: <br />SOAP: PSI: HRS/MIN: BRINE LIQUID ANNULAR): OTHER: <br />4. PRIMARY TANK TEST: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL API/PEI <br />6. <br />PRIMARY PIPING TEST MINIMUM 40 PSI/30 MIN <br />CCR 2636 e <br />7. <br />SECONDARY PIPING CONTAINMENT TEST: PSI: HRS/MIN: <br />OTHER: ICCR 2636 e <br />8. <br />LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: <br />ICCR 2635 a 4 <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />10. OVERSPILL PERFORMANCE TEST <br />fCCR 2635(b)(1)(Cfl <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />CCR 2636(b)] <br />12. PIPING SLOPES TO COLLECTION SUMP <br />CCR 2636 c 1 <br />PIAIA1 1M-QP1=rTInhI <br />13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />FCCR 2632 c 2 <br />14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM <br />CCR 2632 c 2 <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />ICCR 2643 c 1 <br />16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF <br />CCR 2636 <br />17. <br />BALL FLOAT VALVES INSTALLED <br />18. <br />OVERFILL PROTECTION INSTALLED AND APPROVED <br />CCR 2635 b 2 <br />19. <br />TANK ACCESS PORTS BROUGHT TO GRADE LOCKED AND WATERTIGHT <br />API <br />20. <br />TANK INTEGRITY TEST PERFORMED HARD COPY SUBMITTED <br />CCR 2635 a 5 <br />21. <br />MONITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE <br />CCR 2632 d <br />22. "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 />EH23 006 3/18/02 <br />10 <br />