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NEW UST INSTALLATION INSPECTION RECORD <br /> FFACILITY NAME: ADDRESS: <br /> TANK# UL# TANK MODEL/MATERIAL: <br /> RTMENTALIZED TANK? (If yes, complete one form for each tank) ❑YES ❑ NO <br /> APACITY: PRODUCT: <br /> T <br /> ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> SPECIFICATIONS <br /> 1. UST PLANS SUBMITTED AND FEES PAID H&S CODE SECTION 25287 <br /> 2. UST INSTALLATION PLANS APROVED <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT:HOLIDAY TEST: VACUUM: <br /> SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR)7 OTHER: <br /> 4. PRIMARY TANK TEST: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL API/PEI <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST MINIMUM 40 PSI/30 MIN CCR 2636 e <br /> 7. SECONDARY PIPING CONTAINMENT TEST: PSI: HRS/MIN: OTHER: ICCR 2636 e <br /> 8. LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: CCR 2635 a 4 <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10. OVERSPILL PERFORMANCE TEST CCR 2635 b 1 C <br /> 11.ALL PIPING AND FITTINGS CORROSION PROTECTED rCCp 2636 b <br /> 12. PIPING SLOPES TO COLLECTION SUMP ICCR 2636(c)(1" <br /> FINAL INSPECTION <br /> EFORMANCE TEST FOR"ALL"MONITORING PROBES CCR 2632 c 2FORMANCE TEST OF CONTINUOUS MONITORING SYSTEM CCR 2632 c 2FORMANCE TEST OF LINE LEAK DETECTION CCR 2643 c 1FORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF CCR 2636 FLOAT VALVES INSTALLED <br /> RFILL PROTECTION INSTALLED AND APPROVED CCR 2635 b 2K ACCESS PORTS BROUGHT TO GRADE LOCKED AND WATERTIGHT API <br /> K INTEGRITY TEST PERFORMED HARD COPY SUBMITTED CCR 2635 a 5ITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE - CCR 2632 d <br /> 22."C" FORM COMPLETED AND SUBMITTED ICCR 2635 d <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED CCR 2630-2636 <br /> 24. ALL CONDITIONS MET' FACILITY PERMIT ISSUED (H&S CODE 25284 <br /> COMMENTS <br /> EH23 006 3118102 <br /> 10 <br />