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NEW USOSTALLAMN INSPECTION RECOD <br />'ACILITT NAME: ADDRESS: Z Q/ <br />r <br />WEPS9 TANK! UL.f TANK MODEUMATERIAL: <br />APACITY: <br />INITIAL INSPECTIONS <br />A <br />I <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: NOLIDAY: <br />VACUUM: SOAP: PSI: NRS/MIN: BRINNE(LIOUID ANNULAR): QTINRs <br />P <br />N <br />ALL TAMS TO BE INSTALLED AID TESTED IM AccaRDAMCE <br />4. PRIMARY TANK TEST: PSI: NRS/MTN: <br />P <br />I <br />WITN MANUFACTURER WRITTEN SPECIFICATIONS <br />S. TANK APPROPRIATELY PLACED VITN APPROVED BACKFILL (CCR 205 (A) (3) (4) (6)/ API/PEI) <br />R <br />T <br />9. UNUSED TANK OPENINGS SEALED AND COINQSTOM PROTECTED (CCR 2m) <br />0 <br />I <br />10. OVERSPILL PERFORMANCE TEST CC RR 2635 CA), (4)) <br />V <br />A <br />11. ALL PIPING AMD FITTINGS CORROSION PROTECTED (CCR 205 (a)) <br />It <br />E <br />L <br />9. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) CS)) <br />0 <br />S <br />19. TANK INTEGRITY TEST (PASSING NARD COPY) (CCR 2635 (A) (5)) <br />ITEM OR EGUIPMENT INSPECTED <br />DATE <br />21. -C` FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />1. UST PLANS SUBMITTED/ FEES PAID (N+S CODE 25297, CCR 2635 (D) (9) <br />Z. UST INSTALLATION PLANS APPROVED (CCR 205 (2) (5)) <br />INITIAL INSPECTIONS <br />I,- PIPING INSPECTIONS <br />V1 <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: NOLIDAY: <br />VACUUM: SOAP: PSI: NRS/MIN: BRINNE(LIOUID ANNULAR): QTINRs <br />V <br />.,./t <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: RRS/MIM: OTNER: (CCR 2635 (A) (4)) <br />4. PRIMARY TANK TEST: PSI: NRS/MTN: <br />9. LANE TEST ON ALL SUMPS (24 OR. MINIMUM) NRS: CCCR 2635 (A)) <br />S. TANK APPROPRIATELY PLACED VITN APPROVED BACKFILL (CCR 205 (A) (3) (4) (6)/ API/PEI) <br />I,- PIPING INSPECTIONS <br />o ` FINAL INSPECTION <br />6�t7,-Cls <br />V1 <br />6. PRIMARY PIPING TEST (MMMIMRO 40 PSI/30 MIN) (NXIt 2635 (6) (4)) <br />6 'j/7, g <br />V <br />.,./t <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: RRS/MIM: OTNER: (CCR 2635 (A) (4)) <br />r A- <br />9. LANE TEST ON ALL SUMPS (24 OR. MINIMUM) NRS: CCCR 2635 (A)) <br />d,4 <br />9. UNUSED TANK OPENINGS SEALED AND COINQSTOM PROTECTED (CCR 2m) <br />10. OVERSPILL PERFORMANCE TEST CC RR 2635 CA), (4)) <br />11. ALL PIPING AMD FITTINGS CORROSION PROTECTED (CCR 205 (a)) <br />It <br />o ` FINAL INSPECTION <br />6�t7,-Cls <br />V1 <br />12. PERFORMANCE TEST FOR • NG PROBES (CCA 2612 (C) (2)) <br />6 'j/7, g <br />V <br />.,./t <br />13. PERFCR ucF TEST OF COMTINim MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br />r A- <br />14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCA Z= CO) 2635 (S) (5)) <br />d,4 <br />15. PERFORMANCE TEST OF AUTOMATIC PUMP STSTEM SHAT -OFF (CCR am (B) (5)) <br />16. BALL FLOAT VALVES INSTALLED (CCR 2635 (s) (6)) <br />17. OVERFILL PROTECTION INSTALLED/APPROVED COCA 205 (E) (2)) <br />9. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) CS)) <br />19. TANK INTEGRITY TEST (PASSING NARD COPY) (CCR 2635 (A) (5)) <br />20. MONITORING PLAN, RESPONSE PLAN ALD LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br />21. -C` FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />22. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (NSR 2641-2644) <br />23. ALL CONDITIONS NET; FACILITY PERMIT ISSUED (11+6 Cm! 2529; (E) (F)) <br />COMMENTS: <br />EN23-006 3/92 (REVISED 11\92) <br />.;7 <br />