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NEW UST INSTALLATION INSPECTION RECORD <br /> / ✓ f"O.lyADDRESS: <br /> FACILITY NAME: �� �S �( <br /> FACILITY 1D# <br /> TANK# t>!i S 3�V C)l UL# TANK MODEL/MATERIAL: <br /> CAPACITY: <br /> 1 =OD : �� �� �,L R.E.H.S: <br /> A IP NTANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br /> P IWITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 I <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATES PAID (H+S CODE 25287) <br /> APPROVED <br /> INITIAL INSPECTIONS <br /> 3E]]EDARY EST OF SECONDARY CONTAINMENT: HOLIDAY:AP: PSI: HRS/MIN: BRINE(LI WID ANNULAR): OTHER:4T: PSI: HRS/MIN:5LY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> mRY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br /> DARY PIPING CONTAINMENT TEST PSI: t HRS/MIN: OTHER: (CCR 2636 (e)) <br /> TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (LCR 2635 (a) (4))ED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> SPILL PERFORMANCE TEST (CCR 2635 (b) (1)PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> NG SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> 13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (B)) <br /> 17. BALL FLOAT VALVES INSTALLED <br /> 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> 20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> 21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> 22. I FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> 24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EN23-006 7/97 <br /> 10 <br />