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UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: I" , „, , (\ ,\, �- ADDRESS: /_ U? u , 1 w _ - II <br />FACILITY ID# , TANK# UL# TANK MODEL/MATERIAL: <br />CAPACITY: 1a1 6)00 PRODUCT: Ql r 11 a%X R.E.H.S: <br />INITIAL INSPECTIONS <br />A <br />I <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />ACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />R <br />T <br />(e)) <br />;fq— ,C/ <br />1 <br />0 <br />I <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />V <br />A <br />(a) (4)) <br />/ V <br />E <br />L <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />D <br />S <br />1 q- ' <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />(CCR <br />2635 <br />(b) (1) (C)) <br />f <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />Z,2: p <br />✓ <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />ACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />(CCR <br />2636 <br />(e)) <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />L, <br />7. <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />Z,2: p <br />✓ <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />(CCR <br />2636 <br />(e)) <br />L, <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI :s• S HRS/MIN: 3 O OTHER: <br />(CCR <br />2636 <br />(e)) <br />;fq— ,C/ <br />1 <br />7-3 <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />/ V <br />17. <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />1 q- ' <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />f <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />or <br />✓ <br />TSS <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION ii1w 4 n A.../4aAtA) <br />3--I'q- 6t <br />fA <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />(CCR <br />2632 <br />2632 <br />c) <br />(c) <br />(2)) <br />(2)) <br />PERFORMANCE TEST OF LINE LEAK DETECTION , <br />(CCR <br />2643 <br />(c) <br />(1)) <br />;fq— ,C/ <br />1 <br />7-3 <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />02tCR <br />2636 <br />(g)) <br />/ V <br />17. <br />BALL FLOAT VALVES INSTALLED <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) <br />(2)) <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2635 <br />(a) <br />(5)) <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 />10 <br />