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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ADDRESS: <br />FACILITY ID# TANK# l , UL# TANK MODEL/MATERIAL: <br />CAPACITY: ®�� C g PRODUCT: / R.E.H.S: <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />A <br />I <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br />(CCR <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />- <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />(CCR <br />R <br />T <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br />.� <br />0 <br />I <br />OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />(CCR <br />V <br />A <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />�I r <br />E <br />L <br />12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />(CCR <br />D <br />S <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />.. <br />417. <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />(CCR <br />2635 <br />(b) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br />(CCR <br />2632 <br />(c) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br />- <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) NRS: (CCR 2635 (a) (4)) <br />(CCR <br />2632 <br />(c) <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br />.� <br />OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />(CCR <br />2643 <br />(c) <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />�I r <br />12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />COMMENTS:— <br />EH23-006 7/97 <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />(c) <br />(2)) <br />- <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />2632 <br />(c) <br />(2)) <br />.� <br />PERFORMANCE TEST OF LINE LEAK DETECTION t <br />(CCR <br />2643 <br />(c) <br />(1)) <br />�I r <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF a l <br />(CCR <br />2636 <br />(g)) <br />BALL FLOAT VALVES INSTALLED <br />.. <br />417. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) <br />(2)) <br />y� <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />® <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2635 <br />(a) <br />(5)) <br />® <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 7/97 <br />