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NEW UST( INSTALLATION INSPECTION RECORD i <br />FACILITY NAME: <� � t �Gt � � (G , C � � a ��1LG�k ADORESS: �. 6Z -; 0.4-1 F/ / <br />FAC.LITY ID# FAArmjjy T NK* ULA TANK MCOEL/MATERIAL: <br />CAPACITY: PRODUCT: R.E-H.S: <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: 3RINE(LIQUID ANNULAR): OTHER: <br />14. PRIMARY TANK TEST: PSI: HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACKFTLL (API/P£I) <br />PIPING INSPECTIONS <br />A <br />I <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES 1 u,} �� 4- r (CCR 2632 (c) (2)) <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCOROANCE <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />R <br />T <br />I16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (9)) <br />0 <br />I <br />17. BALL FLOAT VALVES INSTALLED <br />V <br />A <br />I18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />E <br />L <br />19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCXED AND WATERTIGHT) APT <br />D <br />S <br />I20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />I22. <br />NC" FUN COMPLETED AND SUBMITTED (CCR 2635 (d)) <br />23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-26.36) <br />1. UST PUNS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: 3RINE(LIQUID ANNULAR): OTHER: <br />14. PRIMARY TANK TEST: PSI: HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACKFTLL (API/P£I) <br />PIPING INSPECTIONS <br />FINAL !NSPECTION71. // 4 0, /j Ak <br />16. PRIMARY PIPING TEST (MINIMUM 40 PS1130 MIN) (CCR 26.36 (e)) <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES 1 u,} �� 4- r (CCR 2632 (c) (2)) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br />14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />I8. <br />LAKE -icST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br />15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 26433 Cc) (1)) <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br />I16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (9)) <br />I10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />17. BALL FLOAT VALVES INSTALLED <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />I18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />I12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />FINAL !NSPECTION71. // 4 0, /j Ak <br />CUIMENTS <br />`FA-AW«M <br />EH23--006 9/95 T � <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES 1 u,} �� 4- r (CCR 2632 (c) (2)) <br />14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 26433 Cc) (1)) <br />I16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (9)) <br />17. BALL FLOAT VALVES INSTALLED <br />I18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCXED AND WATERTIGHT) APT <br />I20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />(21. MONITORING PLAN, RESPONSE PLAN AND LOG 300K ON SITE (CCC 2632 (d)) <br />I22. <br />NC" FUN COMPLETED AND SUBMITTED (CCR 2635 (d)) <br />23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-26.36) <br />I24. ALL =XDITIONS MET; FACILITY PERMIT ISSUED (H+5 CODE 25284) <br />CUIMENTS <br />`FA-AW«M <br />EH23--006 9/95 T � <br />