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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: 3 �b ` <br /> PR# TANK# UL# TANK MODEUMATERIAL: e <br /> COMPARTMENTALIZED TANK? (if <br /> yes, complete one form for each tank) ❑AYES vo <br /> TANK CAPACITY: T"� �A 3 PRODUCT: D 7 3 - 011 <br /> DATE A INITIALS <br /> P <br /> R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> v SPECIFICATIONS <br /> E <br /> D <br /> CD`^ 1. UST PLANS SUBMITTED AND FEES PAID (H&S CODE SECTION 25287 <br /> 2. UST INSTALLATION PLANS APROVED <br /> INITIAL INSPECTIONS <br /> _e 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY TEST: VACUUM: <br /> Wx SOAP: PSI: HRS/MIN: BRINE (LIQUID ANNULAR): 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(ell <br /> Sr. 7. SECONDARY PIPING CONTAINMENT TEST: PSI: HRS/MIN: OTHER: CCR 2636(ell <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 FCCR 2635 b 1 C <br /> 9 as WO- 11.ALL PIPING AND FITTINGS CORROSION PROTECTED CCR 2636 b <br /> � 12. PIPING SLOPES TO COLLECTION SUMP CCR 2636 c 1 <br /> FINAL INSPECTION <br /> 13. PERFORMANCE TEST FOR"ALL" MONITORING PROBES FCCR 2632 c 2 <br /> 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM CCR 2632 c 2 <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION ICCR 2643 c 1 <br /> 0110-7 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF FCCR 2636 <br /> .� 17. BALL FLOAT VALVES INSTALLED <br /> 18. OVERFILL PROTECTION INSTALLED AND APPROVED ICCR 2635 b 2 <br /> ✓ 19. TANK ACCESS PORTS BROUGHT TO GRADE LOCKED AND WATERTIGHT API <br /> ✓ 20. TANK INTEGRITY TEST PERFORMED HARD COPY SUBMITTED CCR 2635 a 5 <br /> L 21. MONITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE FCCR 2632 d <br /> 22."C"FORM COMPLETED AND SUBMITTED TCCR 2635 d <br /> v / 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED CCR 2630-2636 <br /> ✓j <br /> 11 JI 24. ALL CONDITIONS MET'FACILITY <br /> {PERMIT ISSUED, H&S CODE 25284 <br /> 1 - 1 J /� <br /> COMMENTS /� J2 �F— 6ic \ � IWx— <br /> EH23 006 3118102 <br /> 10 <br />