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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: 7 e 0 <br /> (FACILITY ID# TANt# _010 516:5 UL# 74f JS TANK MODEL/MATERIAL: <br /> CAPACITY: ,O D/')/\ �� /77 PRODUCT: fle (v/ R.E.H.S: 1 <br /> A I IV <br /> P N ALL TANKS TO BE INSTALLED AND TESTED IN ACCOR ANCE <br /> P 1 WITH MANUFACTURER WRITTEN SPECIFICATION <br /> ION <br /> T <br /> V A +z �, <br /> E L Wl �� \ <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE f <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> O 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> y_ INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: D, K <br /> VACUUM: SOAP: /PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> 9_ D PRIMARY TANK TEST: u PSI: HRS/MIN: <br /> ✓ 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br /> (AP /PEI) <br /> PIPING INSPECTIONS <br /> l���,V\ ✓ 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) Q (LCR 2636 (e)) <br /> _p( <br /> T. SECONDARY PIPING CONTAINMENT TEST PSI� LSHRS/MIN: 30 MOTHER: (CCR 2636 (e)) <br /> 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) d HRS: '1 (CCR 2635 (a) (4)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED V OC4a44y,PEI <br /> \� ✓ 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> �+-�l-�V � ✓ 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 (LCR 2632 (c) (2)) <br /> V 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (LCR 2632 (c) (2)) <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> 5 0� ✓ 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br /> kk <br /> _U 7. BALL FLOAT VALVES INSTALLED <br /> 11 -� 8. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> 0. TANK INTEGRITY TEST (PASSING HARD COPY) '�P1•�' (CCR 2635 (a) (5)) <br /> p1 ✓ MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> "C" FORM COMPLETED AND SUBMITTED tipJG "� (CCR 2635 (d)) <br /> l'vlq-o� <br /> MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> 1 , ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23-006 9/95 <br /> 10 0 <br />