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UST INSTALLATION INSPECTION RECORD <br /> IL/ �. A/1 �y <br /> J ADDRESS: � • �(. _Li� /� l <br /> FACILITY NAME: 1. i �4 Alt TANK MODEL/MATERIAL: <br /> TANKSFACILITY IDX J0 ,�,,�' <br /> PRODUCT: f�lZc'Ntil a IJ w/L a.E.X_s: r GO <br /> CAPACITY: �, 000 <br /> A L At� <br /> ALL TANKS TO eE INSTALLED AND TES}ID IN ACCOROAMCE <br /> P N WITH MANUFACTURER WITTEN SPECIFICATIONS <br /> P I __ <br /> R T <br /> 0 I <br /> Y A L '� <br /> -c L <br /> D S - <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> (H+5 CODE 25287) <br /> L, UST PIANS SUBMITTED/ FEES PAID <br /> UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> INSPECTION AND TEST OF SECONOAR7 CONTAINMENT: <br /> HOLIDAY: <br /> VACUUM: I 7 SOAP: PSI: 4RSMIN: ` 3RINE(LIQUID ANNULAR): OTHER: <br /> / <br /> 4, PRIMARY TAN TEST: PSI: NRS/NIH: <br /> � (AP[lPEI) <br /> C I lI � '/ '< � TANK APPROPRIATELY PLACED 4ITH APPROV® dAIXFIl1 <br /> PIPING INSPEC7ICNS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/3O MIN) <br /> (CCC 1636 Cel) <br /> / •a V- 111111 <br /> PSI: ARS/MI <br /> 7• SECONDARY PIPING CONTAINMERT TEST N: OTHER: (CQ 2636 (e)) <br /> Z l -�� 8. LAKE TEST ON ALL SUMPS (24 XR. MINIMUM) <br /> �,[J HRS: (CQ 2635 Ca) (y)7 <br /> PEI <br /> 9, UNUSED TANK OPENINGS SEALED AND CCRROSLON PROTECTED (CCR 2635 (b) (1) (C)) <br /> a� 9q GVERSPILL PERFORMANCE TEST <br /> • (CQ 2636 (b)) <br /> Z ZQ 1, ALL PIPING AND FITTINGS CORROSION PROTECTED <br /> / (CQ 7636 (c)C1)) <br /> • L -y0 . '2, PIPING SLOPES 70 COLLECTION SUMP <br /> ,I FINAL INSPECTION <br /> PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br /> (CQ 7632 (c) (2)) <br /> PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CQ 2632 (c) (2)) <br /> PERFORMANCE TEST OF LINE LEAK DETECTION Ir P t (CQ 2643 (c) (1)) <br /> a <br /> PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF �t, (CCA 2636 (B)) <br /> 17' BALL FLOAT VALVES INSTALLED )�', (�.Q. (N��U II ed D <br /> i8.qq I OVERfILL PROTECTION <br /> (CQ 2635 (b) (2)) <br /> LNSTAILID/APPROVED <br /> / TANK ACCESS PORTS 3ROUGHT TO GE (LOCKED AND WATERTIGHT) <br /> API <br /> RAD <br /> V (CQ 2635 (a) (5)) <br /> �- o ! I. _ TANK INTEGRITY TEST (PASSING HARD COPY)V I21. MONITORING PLAN, RESPONSE PLAN AND LOG 300K ONSITE (CQ 7632 (d)) <br /> (GOR 2635 (d) <br /> I22, "C^ FORM COMPLETED AND SUBMITTED <br /> ) <br /> [] I' ((CQ 26.30-26.36) <br /> MONITORING MEi1100 FOR ALL tANKS AND PIPING APPROVED <br /> 1 I <br /> 24, ALL CCNOITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> C8 ` /G <br /> COMNEHTS: ^ - 1 0 v <br /> EH23-006 9/95 7 <br />