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WELT UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: 4U (Cl< '20O I ZCJ ADDRESS: � `�"/ v ' 10v�Y� <br />FACILITY IO# TANKS UL* S(o TANK MODELIMATERIAL: <br />CAPACITY: 002) PRODUCT: <br />INITIAL INSPECTIONS <br />3- INSPECTION AND TEST OF SE=10ART CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN:3RINE(LICUID ANNULAR): OTHER: <br />4. PRIMARY TANK TEST: PSI: 4 HRSMIN: "�o 0 r,� <br />TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFILL (APT/PEI) <br />w <br />lb <br />16 I � <br />A <br />I <br />CC= 2636 (e)) <br />D_� G I ✓ <br />�(� 7. <br />P <br />N <br />ALL TANKS TO SE INSTALLED AMC TESM IN AC= RDANC <br />8. <br />LAKE icST ON ALL SUMPS (24 HR_ MINIMUM) ARS: <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATICNS <br />UNUSED TANK CP@aINGS SEALED AND CC•RROSION PROTECTED <br />PEI <br />R <br />T <br />OVERSPILL PERFORMANCE TEST <br />(= 2535 Ch) C1) (C)) <br />,U-!� I ✓ <br />O <br />I <br />(CCR 26.36 (b)) <br />IH412. <br />PIPING SLOPes TO COLLcCTION SUMP <br />V <br />A <br />El <br />API <br />E <br />L <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />CCCR 2535 (a) (5)) <br />0 <br />S <br />MONITORING PLAN, RESPONSE PLAN AND LOG 3OCK ON SITE <br />(CCE 2532 (d)) <br />122. <br />ITEM OR EflUIPMENT INSPECTffi <br />(i"uR 26:35 <d)) <br />DATE <br />70 <br />I I,,,, I23. <br />MONITCRING METHOD FOR ALL TANKS AND PIPING APPROVED <br />CC= 2630-�6) <br />1. UST PIANS SUBMITTED% FES PAID CH+S CME ?5an <br />mt� <br />I 12. <br />UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />3- INSPECTION AND TEST OF SE=10ART CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN:3RINE(LICUID ANNULAR): OTHER: <br />4. PRIMARY TANK TEST: PSI: 4 HRSMIN: "�o 0 r,� <br />TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFILL (APT/PEI) <br />w <br />lb <br />16 I � <br />I��t 6. <br />PRIMARY PTPTNG TEST (MINIMUM 40 PSI/30 MIN) 50 10-T 3 a <br />CC= 2636 (e)) <br />D_� G I ✓ <br />�(� 7. <br />SECCNDARY PTPTNG CONTAINMENT TEST PSI: HRS/MIN:3C) OTHER: <br />(CCR 2636 (e)) <br />�✓ bl <br />8. <br />LAKE icST ON ALL SUMPS (24 HR_ MINIMUM) ARS: <br />(CCR 26.35 (a) (4)) <br />r0 <br />9. <br />UNUSED TANK CP@aINGS SEALED AND CC•RROSION PROTECTED <br />PEI <br />Z� ( ✓ <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(= 2535 Ch) C1) (C)) <br />,U-!� I ✓ <br />Ny41I. <br />ALL PIPING AND FITTINGS CORROSION PROTE:.ic7i <br />(CCR 26.36 (b)) <br />IH412. <br />PIPING SLOPes TO COLLcCTION SUMP <br />(Cum 2636 (c)(1)) <br />FINAL ZNSPEC710M <br />CCZMMENTS: <br />EH23-306 9/95 7 <br />13. <br />P6tFORMANCZ TEST FOR "ALL" MONITORING PROBES <br />CC= 2632 (c) (2)) <br />�bi 6 <br />I 14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />CC= 2532 (c) (2)) <br />�b <br />I 15. <br />PEZFORMANCE TEST OF LINE LEAK DETEC.4ION <br />(Gat 2543 Cc) (1)) <br />r0 <br />I16. <br />PERFORMANCZ- TEST OF AUTOMATIC PUMP SYSTEM SHUT -AFF <br />CCui 2636 (4)) <br />Z� ( ✓ <br />ft. { l7. <br />&ALL FTAAT VALVES INSTALLED <br />lUA,,f [ <br />I <br />IKj�18. <br />CVERFiLL PROTECTION INSTALLS /APPROVED <br />CC*..'t 2635 (b) (2)) <br />10''ul al <br />I ol19. <br />TANK ACCESS PORTS &ROUGHT TO GRADE (LOCXS AND WATE'iTIGHT) <br />API <br />�20. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />CCCR 2535 (a) (5)) <br />MONITORING PLAN, RESPONSE PLAN AND LOG 3OCK ON SITE <br />(CCE 2532 (d)) <br />122. <br />"C" FORM COMPLETED AND SUBMITTED <br />(i"uR 26:35 <d)) <br />I I,,,, I23. <br />MONITCRING METHOD FOR ALL TANKS AND PIPING APPROVED <br />CC= 2630-�6) <br />/ b <br />mt� <br />IZ4. <br />ALL =XDITTONS MET; FACILITY PERMIT ISSUED <br />(H+S CSE 25G84) <br />CCZMMENTS: <br />EH23-306 9/95 7 <br />