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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: <br /> PR# TANK# UL# TANK MODEUMATERIAL: <br /> COMPARTMENTALIZED TANK? (If yes, complete one form for each tank) ❑YES ❑ NO <br /> TANK CAPACITY: PRODUCT: <br /> DATE A INITIALS <br /> P <br /> P <br /> R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> v SPECIFICATIONS <br /> E <br /> D <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): 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 /> 7. SECONDARY PIPING CONTAINMENT TEST:PSI: HRS/MIN: OTHER: fCCR 2636(e)] <br /> 8. LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: ICCR 2635 a 4 <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10.OVERSPILL PERFORMANCE TEST ICCR 2635 b 1 C <br /> 11.ALL PIPING AND FITTINGS CORROSION PROTECTED fCCR 2636 b <br /> 12. PIPING SLOPES TO COLLECTION SUMP FCCR 2636 c 1 <br /> FINAL INSPECTION <br /> 13. PERFORMANCE TEST FOR"ALL"MONITORING PROBES ICCR 2632 c 2 <br /> 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM FCCR 2632 c 2 <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION FCCR 2643 c 1 <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF FCCR 2636 <br /> 17. BALL FLOAT VALVES INSTALLED <br /> 18. OVERFILL PROTECTION INSTALLED AND APPROVED CCR 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 /> 21. MONITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE FCCR 2632 d <br /> 22."C"FORM COMPLETED AND SUBMITTED FCCR 2635 d <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED FCCR 2630-2636 <br /> 24. ALL CONDITIONS MET;FACILITY PERMIT ISSUED (H&S CODE 25284 <br /> COMMENTS <br /> EH23 008 3/18/02 <br /> 10 <br />