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NEW UST INSTALLATION INSPECTION RECORD <br /> FAC:L,'TY NAME: D � ADDRESS: 13 Q <br /> FACILITY ID.". iANK;* _ UL: TANK MCOEL/MATERIAL: <br /> �C.APAC:TY: /� Q PRODUCT: r� R.c.:{_S: <br /> 11 A I <br /> p N ALL TANKS TO 3E INSTALLED ANO TESTED IN AC=OANCE <br /> p ( WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 I <br /> V I A <br /> E L <br /> D S <br /> ITEIM OR ECUIPMENT INSPECT <br /> DATE <br /> 1. UST ?(..ANS SUBMITTED/ c.S PAID (HSS CODE 25287) <br /> 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTICNS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VAC.'LM: SOAP: PSI: HRS/MIN: 3RINECLICUI0 ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> 5. TANK APPROPRIATELY 'aITH APPROVED 3ACXFILL CAP[/PET/ <br /> PIPING INSPEC CHS <br /> PRIMARY PIPING TEST (MINIMUM 40 ?S1/30 ,MIN) CCCR 2636 (e)) <br /> �' _ q ✓ I SECONDARY PIPING CONTAINMENT TEST PSI: 3 HRS/MIN: OTHER: (CCR 2636 (e)) <br /> LA1Cc TEST ON ALL-SUMPS (24 :AR. .MINIMUM)' HRS: 7/L (CCR 2615 (a) c4)l <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION ?ROTECTED PET. <br /> V OVERSPILL PERFORMANCE 7=-ST (C--R 2635 (b) Ci) (C)) <br /> 1 Y <br /> Til. ALL ?!PING ANDFiii:IGS CORROSION ?RCTEC:E) (CCR 26636 (b)) <br /> I <br /> V �. PIPING SLOPES 70 CCL-' =C-,ICN SUMP (CCR 26.36 (c)(1)) <br /> V <br /> .-:NAL :NSPEC':ON <br /> PERFORMANCE TEST FOR "ALL" ,MONITORING PROBES (CCR 26:z Cc) (2)) <br /> 1 <br /> ` l�� / I PERFORMANCE 'EST OF =14TINUCUS .MONITORING SYSTEM (PANEL (CCR 2632 (c) (2)) <br /> l I I ✓ PERFORMANCE TEST OF -`XE LEAK DETECTICN (CCR 2643 Cc) (')) <br /> 16. PERFORMANCE CST OF AUTOMATIC PUMP SYSTEM SHUT-OFF 1 C ..R 2636 (g)) <br /> 17. BALL FLOAT '/ALVES INSTALLED I <br /> 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 119. TANK ACCESS PORTS 3ROUGHT TO GRADE (LOCXED AND_s1ATE.RTIGHT) API <br /> 20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> S <br /> MONIT G PLAN, RESPONSE SAN AND LOG 3CCK ON SI=ig _t S CCCR 26.32 (d)) <br /> 1 22. "C" FORM COMPLETED AND SUBMITTED (CCR 26.35 (d)) <br /> P-/A-j y� oft. 14CN17CRING METHOD FOR .ALL TANKS AND PIPING APPROVED (C=Z 2630-2636) <br /> I24. ,ALL =NOITIONS MET; 'AC.Li7Y PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: -3-a� { l °n; ,C , C�1/2NX.(� /�� ; bQ�P� J2 n,& ./�t��/D� /�. <br /> EH23-006 9 95 � '-/7O-. `5 <br /> LSP �� e <br /> 10 <br />