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NEW U ` INSTALLATION INSPECTION RE&RD <br /> FACILITY MAKE: S ADDRESS:•� iVVll�^ <br /> SL'EEPS# TAN" UL# TANK MOOEL/MATERIAL: <br /> OPACITY: Q) PRODUCT: uty ' Q �T 43oi_ R.E.H.S: <br /> A I V K <br /> P MALL TANKS TO BE INSTALLED AND TESTED IM ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 I <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> 3�f7 R „� ;� 2_ UST INSTALLATIOM PLANS APPROVED iJ�Z[�c fL �CiI /w s (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> 3 f 3- INSPECTION AND TEST OF SECOMDARY CONTAINMENT: HOLIDAY: <br /> VAC": �0" SOAP: PST: MRS/MIM: A i,"r BRINE<LICUID AMNULAR): OTHER_ <br /> 4_ PRIMARY TANK TEST: PSI: HRS/MIM: <br /> I - 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> 6_ PRIMARY PIPING TEST (MINIMUM 40 PSI/3O MIH) y (CO2 7_635 (6} (4)) <br /> z% <br /> Cf� ✓ 7. SECONDARY PIPING CONTAINMENT TEST PSI:S HRS/MIN-- OTHER: (CCR 2635 (A) (4)) <br /> 3/z g IS `/ S. LACE TEST ON ALL SLWS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br /> n g / 9. UNUSED TANK OPENINGS SEALED AMD CORROSION PROTECTED (CCR 2635) <br /> b � V - OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> QS f 11- ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSP€CTION <br /> s 12- PERFORMANCE TEST FOR -ALL- MONITORING PROBES (CCR 2632 (C) (2)) <br /> 3. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> 14. PERFORMANCE TEST OF LIME LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> /�U a �u 15. PERFORMANCE TEST OF AUTOMATIC PUMA SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> _6 sy5 6_ BALL FLOAT VALVES INSTALLED (crse 2635 (B) (6)) <br /> OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br /> 13. TANK ACCESS PORTS BROUGHT TO GRADE (LDCXED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> 5 r 19- TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)} <br /> r <br /> ft, 20- MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 26.2 (E) (1) (2)) <br /> 21. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br /> s- - MONITORING METHOD FOR ALL TANTS AND PIPING APPROVED (CCR 2641-2544) <br /> 23_ ALL CORDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) M) <br /> CCMMIEMTS <br /> EH23--005 3/92 (REVISED 11\92) <br />