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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ADDRESS: <br />FACILITY ID# J! TANK# 1 Aj, IF— <br />O `7 UL# TANK MODEL/MATERIAL: <br />CAPACITY: �V O ��' PRODUCT: R.E.H.S: <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 />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 />2636 <br />(e)) <br />0 <br />I <br />f <br />8. <br />V <br />A <br />(CCR <br />2635 <br />E <br />L <br />?�.If <br />D <br />S <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />PEI <br />2635 <br />(b) (2)) <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />Y� bf <br />✓ <br />( <br />l <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />✓6. <br />3. <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />/ � VWVj5CR <br />►'`(CCR <br />2636 <br />(e)) <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />V/SECONDARY <br />PERFORMANCE TEST OF LINE LEAK DETECTION r/Jj�� I <br />(CCR <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION A_ j _ --;- <br />2„ �„ <br />7 �f <br />✓6. <br />3. <br />PERFORMANCE TEST FOR "ALL" MONITORING PRO ES <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SY M (PANEL) <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) b Q <br />/ � VWVj5CR <br />►'`(CCR <br />2636 <br />(e)) <br />D� <br />V/SECONDARY <br />PERFORMANCE TEST OF LINE LEAK DETECTION r/Jj�� I <br />(CCR <br />PIPING CONTAINMENT TEST PSI: S S HRS/MIN: <br />3e OTHER: <br />2636 <br />(e)) <br />3_ G <br />✓ <br />f <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) %,� <br />HRS: ; (, <br />(CCR <br />2635 <br />(a) (4)) <br />S'0 <br />?�.If <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSIOON PROTECTED <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />PEI <br />2635 <br />(b) (2)) <br />lq —0 1 <br />V <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />? , ��. V� <br />i <br />✓ <br />( <br />l <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />�O <br />(CCR <br />2636 <br />(b)) <br />O` <br />2632 <br />(d)) <br />PIPING SLOPES TO COLLECTION SUMP <br />22. <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION A_ j _ --;- <br />2„ �„ <br />7 �f <br />/ <br />3. <br />PERFORMANCE TEST FOR "ALL" MONITORING PRO ES <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SY M (PANEL) <br />CCR <br />(CCR <br />2632 <br />2632 <br />(c) (2)) <br />(c) (2)) <br />'� <br />,✓ <br />5. <br />PERFORMANCE TEST OF LINE LEAK DETECTION r/Jj�� I <br />(CCR <br />2643 <br />(c) (1)) <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT -OFF kn <br />(CCR <br />2636 <br />(g)) <br />17. <br />BALL FLOAT VALVES INSTALLED <br />61 rn 0— <br />?�.If <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 />1 <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2635 <br />(a) (5)) <br />�O <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR <br />2632 <br />(d)) <br />22. <br />"C" FORM COMPLETED AND SUBMITTED i t- <br />(CCR <br />2635 <br />(d)) <br />23. <br />MONITORING METHOD FOR ALL TANKS AND PIPING A PROV D <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 />