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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME:,-,---�� ADDRESS:_� /(,/- '` <br />FACILITY ID# 3%qC'r TANK# UL;* � �TANK MODEL/MATERIAL: ullo lurjd <br />CAPACITY: ���� C1I PRODUCT: R.c.H.S: <br />INITIAL INSPECTIONS <br />l 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: JI) SOAP: �% PSI:_ HRS/MIN:<.H t BRINE(LIQUID ANNULAR): OTHER: <br />/J V 1 4. PRIMARY TANK TEST:Ir l �.� �/ / "— HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />A <br />I <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />R <br />T <br />Z Z <br />V <br />0 <br />1 <br />I <br />112. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />V <br />A <br />(c) (1)) <br />L <br />E <br />L <br />16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />D <br />S <br />(g)) <br />b j�/pir <br />j� <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />Z/j�-f <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />l 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: JI) SOAP: �% PSI:_ HRS/MIN:<.H t BRINE(LIQUID ANNULAR): OTHER: <br />/J V 1 4. PRIMARY TANK TEST:Ir l �.� �/ / "— HRS/MIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) CCCR 2636 (e)) <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN:OTHER: (CCR 2636 (e)) <br />Z <br />I i <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br />J ( y <br />✓ <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />/ <br />10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br />Z Z <br />V <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br />is <br />I <br />112. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />COMMENTS:— <br />EH23-006 7/97 <br />10 <br />ffl13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />Cc) (2)) <br />14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />2632 <br />(c) (2)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR <br />2643 <br />(c) (1)) <br />L <br />16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />2636 <br />(g)) <br />b j�/pir <br />j� <br />17. <br />BALL FLOAT VALVES INSTALLED <br />Z/j�-f <br />18. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) (2)) <br />Q z C.h <br />✓ <br />�/ <br />19. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />20. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2635 <br />(a) (5)) <br />1 Q S <br />1-,-1J <br />21. <br />MONITORING PLAN, RESPONSE PLAN AND LOG 3O0K ON SITE <br />(CCR <br />2632 <br />(d)) <br />Z <br />L <br />, <br />22. <br />23. <br />"C" FORM COMPLETED AND SUBMITTED <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR <br />(CCR <br />2635 (d)) <br />2630-2636) <br />24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S <br />CODE <br />25284) <br />COMMENTS:— <br />EH23-006 7/97 <br />10 <br />