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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: s ADDRESS: 1 F, - <br /> FACILITY ID# `3 J 11 ' TANK# �) UL# j TANK MODEL/MATERIAL:!/(/ / c <br /> CAPACITY: / (J (/ PRODUCT: ({� j. , R.E.H.S: j <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 I <br /> V A <br /> E L <br /> D S <br /> DATE <br /> ITEM OR EQUIPMENT INSPECTED <br /> C°.h <br /> 1, .-1 1`7 Z UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> - - UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> V1 INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: 777, <br /> VACUUM: SOAP: PSI: HRS/MIN:3 D , BRINE(LIQUID ANNULAR): OTHER: <br /> aG- 19'_ 4. PRIMARY TANK TEST: VACj4 tc m 'd h . PSI: HRS/MIN: 3 0 w <br /> '�-��,- I g ✓ 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> - 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) �j s ����Jvw(CCR 2636 (e)) p <br /> / SECONDARY PIPING CONTAINMENT TEST PSI: NRS/MIN: OTHER: (CCR 2636 (e)) <br /> Pf <br /> _' .a LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br /> Ay <br /> q-lb s ✓ UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> .�1 OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> 1. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> ob ) <br /> PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION 5 f�of (CCR 2643 (c) (1)) <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br /> Y'3 0-% eo,37. BALL FLOAT VALVES INSTALLED <br /> fOVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> UZ„_q J1j 19. TANK ACCESS',PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> `V TANK INTEGRITY TEST (PASSING HARD COPY) LL sata p (CCR 2635 (a) (5)) <br /> 21. MONITORING PLAN, RESPONSE PLAN AND LOG 00K SITE 1 (CCR 2632 (d)) <br /> "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 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 /> EH23-006 9/95 <br /> 10 <br />