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• NEN UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: <br /> �IEG D /W"j � P <br /> FACILITY ID# A;5 JY TANK# 4"-S' U L# �d3 NK MODEL/MATERIAL: <br /> CAPACITY: f0i 1:7170 64 PRODUCT: V' R.E.H.S: <br /> A I <br /> P N ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 1 <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H-S CODE 25287) <br /> ,y 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 0'14 INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> l ACWM• .462P- PSI: HR N BRINE(LIOUID ANNULAR): OTHER: <br /> tr 4. PRIMARY TAIAK TEST: PSI: HRS/MIN: <br /> v <br /> ✓ 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> /U <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI:0 HRS/&.3-0 OTHER: (CCR 2636 (e)) <br /> 5 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS:t.+ (CCR 2635 (a) (4)) <br /> 1 rfq�kk I vIlp- 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 7-'1 q-I ✓ OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> if I E� 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> 12. PIPING SLOPES TO COLLECTION SUMP CLLR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> �_,d'95fi� ✓ PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> •,8��-I PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br /> (CCR 2636 (g)) <br /> J' 17. BALL FLOAT VALVES INSTALLED lv?6 (� 5 I dL&7/1 <br /> OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT).ZH API <br /> ve <br /> /I. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> 21. MONITORIN PLAN, RE PONS PLAN AN BOOK ON S (CCR 2632 (d)) <br /> a•��" �� "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> I24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23-0O6 9/951 l <br /> 10 Sisp <br />