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NEG UST INSTALLATION INSPECTION RECORD <br />:ACILITY NAME.f / ADDRESS:`Jy <br />ACILlTY ID#P� ��tV�� TANK# UL#C�-, < TANK MODEL/MATERIAL: <br />:APACITY: LDOv l(/w PRODUCT: �J R.E.H.S:csv <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM:,,,'/, SOAP:�3 PSI: r'S HRS/MIN:'7(,';k,n 3RINE(LIQUID ANNULAR): OTHER: <br />M(( 4. PRIMARY TANK TEST:, 1. /��I� ` �I! HRS/MIN: <br />Lf I v 5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACKFILL (API/PEI) <br />!! PIPING INSPECTIONS <br />A <br />I <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANC` <br />g Z G <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />SECONDARY PIPING CONTAINMENT TEST PSI:. MRS/MIN: OTHER: <br />R <br />T <br />(e)) <br />0 <br />I <br />PERFORMANCE TEST OF LINE LEAK DETECTION /�N yj <br />(CCR <br />V <br />A <br />(1)) <br />�/Z <br />E <br />L <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />(CCR <br />D <br />S <br />22 <br />S <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />l/ S� <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />(b) (1) (C)) <br />Z Z <br />�CY <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM:,,,'/, SOAP:�3 PSI: r'S HRS/MIN:'7(,';k,n 3RINE(LIQUID ANNULAR): OTHER: <br />M(( 4. PRIMARY TANK TEST:, 1. /��I� ` �I! HRS/MIN: <br />Lf I v 5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACKFILL (API/PEI) <br />!! PIPING INSPECTIONS <br />FINAL INSPECTION <br />GLa <br />��I <br />13. <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />(CCR <br />2636 <br />(e)) <br />g Z G <br />14. <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI:. MRS/MIN: OTHER: <br />(CCR <br />2636 <br />(e)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION /�N yj <br />(CCR <br />2643 <br />(c) <br />(1)) <br />�/Z <br />\ <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />22 <br />S <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />l/ S� <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />Z Z <br />�CY <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />j. <br />�12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />GLa <br />��I <br />13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />(c) <br />(2)) <br />g Z G <br />14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />2632 <br />(c) <br />(2)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION /�N yj <br />(CCR <br />2643 <br />(c) <br />(1)) <br />�/Z <br />f 16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />2636 <br />(g)) <br />17. <br />BALL FLOAT VALVES INSTALLED <br />7 �G <br />✓ <br />18. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) <br />(2)) <br />S <br />/,119. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />Asn <br />0. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2635 <br />(a) <br />(5)) <br />21. <br />MONITORING PLAN, RESPONSE PLAN AND LOG SOCK ON SITE <br />(CCR <br />2632 <br />(d)) <br />22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR <br />2635 <br />(d)) <br />Z/j <br />f 23. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR <br />2630-2636) <br />124. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S <br />CODE <br />25284) <br />COMMENTS:- <br />EH23-006 7/97 <br />10 <br />