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EW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: /4 1 . n _ _ A �c ADDRESS: 1n q 7 _ 771 1 u pJ.p .A 11 <br />FACILITY ID# TANK# / / * g- C) UL# TANK MODEL/MATERIAL: <br />CAPACITY: 1_) ,�nA, - Q . PRODUCT: `/ I AA;0lAA 0 R.E.H.S: X75, A , e;z2K� <br />INITIAL INSPECTIONS <br />A <br />I <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />(e)) <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />2632 <br />2643 <br />R <br />T <br />(CCR <br />2636 <br />0 <br />I <br />✓ <br />�' <br />V <br />A <br />3 Q <br />(CCR <br />E <br />L <br />,1' 01 <br />✓ <br />D <br />S <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />(CCR <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />10. <br />OVERSPILL PERFORMANCE TEST <br />API <br />(CCR <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />(b) (1) (C)) <br />0 <br />✓1 <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />2.2'701 <br />✓ <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />3d <br />Cp <br />4- PRIMARY TANK TEST: PSI: HRS/MIN: <br />(e)) <br />0 <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />2.2'701 <br />✓ <br />PERFORMANCE TEST FOR "ALL" MONITORING PRO ES <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) ST <br />3d <br />(CCR <br />2636 <br />(e)) <br />0 <br />V/ <br />Y <br />2632 <br />2643 <br />SECONDARY PIPING CONTAINMENT TEST PSI: !;_SHRS/MIN: 0 <br />OTHER: <br />(CCR <br />2636 <br />(e)) <br />�,�_�} <br />✓ <br />�' <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) 3 S' �� HRS: <br />3 Q <br />(CCR <br />2635 <br />(a) (4)) <br />,1' 01 <br />✓ <br />i r <br />W <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />(CCR <br />2635 <br />(b) (2)) <br />10. <br />OVERSPILL PERFORMANCE TEST <br />API <br />(CCR <br />2635 <br />(b) (1) (C)) <br />0 <br />✓1 <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(a) (5)) <br />(CCR <br />2636 <br />(b)) <br />3 Z-01 <br />V <br />2632 <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />COMMENTS <br />EH23-006 9/95 <br />✓ <br />PERFORMANCE TEST FOR "ALL" MONITORING PRO ES <br />(2)) <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR <br />(CCR <br />2632 <br />2643 <br />(c) (2)) <br />(c) (1)) <br />!`D <br />V <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />2636 <br />(g)) <br />17. <br />BALL FLOAT VALVES INSTALLED <br />O <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) (2)) <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />7v <br />✓1 <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2635 <br />(a) (5)) <br />.i <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR <br />2632 <br />(d)) <br />22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR <br />2635 <br />(d)) <br />23. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR <br />2630-2636) <br />24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S <br />CODE <br />25284) <br />COMMENTS <br />EH23-006 9/95 <br />