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qw NEW USIMSTALLATION INSPECTION <br />FACILITY MAME:ADDRESS: �� �✓ /GGa.,, <br />SHEEPS9 Z,3 TAW UL* TAMIL -MATERIAL: <br />INITIAL INSPECTIONS <br />A <br />P <br />I <br />M <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />VACUUM: SOAP: PST: NRS/MIN: BRIME(LIQUID ANMJLA1R): OTHER: <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />4.PRIMARY TANK TEST: PSI: NRS/NIN: <br />R <br />T <br />9. 1 NISED TANK OPENINGS SEALED AND CMMION PROTECTED (CCR 2m) <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />0 <br />I <br />V <br />A <br />(CCR 2635 (N) (5)) <br />E <br />L <br />BALL FLOAT VALVES INSTALLED <br />(CCA 2635 (S) CO) <br />D <br />S <br />17. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 205 (E) (2)) <br />6 -Z2' l <br />STEN ON EQUIPMENT INSPECTED <br />DATE <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCXEi) AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />19. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />1. UST PLANS SUBMITTED/ FEES PAID (M4.9 CODE 25297, C[R 2635 (D) (8) <br />20. <br />.2. INSTALLATION PLANS APPROVED (CCA 205 (E) (5)) <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />,y <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) S z- pv c7 r -.I- (CLR 2635 (N) (4)) <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: NOLIDAY: <br />VACUUM: SOAP: PST: NRS/MIN: BRIME(LIQUID ANMJLA1R): OTHER: <br />7. SECONDARY PIPING CONTAINMENT TEST PST:S,5�1NRS/MIN:3� OTHER: (CCA 2(135 (A) (4)) <br />S <br />r 13. <br />4.PRIMARY TANK TEST: PSI: NRS/NIN: <br />(CCR 2632 (A) (2)) <br />9. 1 NISED TANK OPENINGS SEALED AND CMMION PROTECTED (CCR 2m) <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />PIPING INSPECTIONS <br />,y <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) S z- pv c7 r -.I- (CLR 2635 (N) (4)) <br />S <br />(COR 2A32 (C) (2)) <br />7. SECONDARY PIPING CONTAINMENT TEST PST:S,5�1NRS/MIN:3� OTHER: (CCA 2(135 (A) (4)) <br />S <br />r 13. <br />LAKY TEST ON ALL SNJMP!< (24 NR. MINIMUM) MRS: (CCR 205 (A)) <br />(CCR 2632 (A) (2)) <br />9. 1 NISED TANK OPENINGS SEALED AND CMMION PROTECTED (CCR 2m) <br />6 <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />10. OVERSPILL PERFORMANCE TEST (COR 2635 (A) (4)) <br />ALL PIPING AID FITTINGS CORROSION PROTECTED (= 2m (8)) <br />FINAL INSPECTION <br />(4-ZZ-lf. <br />1 <br />PERFORMANCE TEST FOR •ALL' MONITORING PROBES <br />(COR 2A32 (C) (2)) <br />l <br />�/ <br />r 13. <br />PERFORMANCE TEST OF C NRTINIdIS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (A) (2)) <br />14. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR 2632 (D) 2635 (3) (5)) <br />15. <br />PERFORMANCE TEST OF ARUYOYITIC PUMP SYSTEM SHUT-OFF <br />(CCR 2635 (N) (5)) <br />16. <br />BALL FLOAT VALVES INSTALLED <br />(CCA 2635 (S) CO) <br />17. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 205 (E) (2)) <br />6 -Z2' l <br />✓, <br />18. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCXEi) AND WATERTIGHT) <br />(CCR 2631 (D) (5)) <br />19. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(OCR 2635 (A) (5)) <br />20. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(COR 2632 (E) (1) (2)) <br />21. <br />•C• FORM COMPLETED AND SUBMITTED <br />(COt 205 (E)) <br />22. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2641-26") <br />23. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(N+S CODE 25284 (E) (F)) <br />COMMENTS: <br />ER23-006 3/92 (REVISED 11\92) <br />