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IVCVV U, INJ I HLLA I IUN 1N5NtU I IUN HI: lH0 <br /> !TT NAME: ADDRESS: Tr <br /> :FPS$ J GJy TANKI OL; TANK MODEL/MATERIAL: � <br /> UPACITY: /�!� PRODUCT: (/ <br /> R.E.H.S: <br /> A I <br /> P N ALL TANKS TO BE INSTALLED AND TESTED IM ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 t <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> [DATE <br /> / Ti7 9� 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> /O +�j2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS / <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIM: BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/3O MIM) psi �( 2635 (B) (4)) <br /> SECONDARY PIPING CONTAINMENT TEST PSI:ZO HRS/111N:1�e o H R: (CCR 2635 (A) (4)) <br /> G� 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (A)) <br /> (�/ ✓ ( 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> i 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> 112. PERFORMANCE TEST FOR 'ALL" MONITORING PROBES (CCA 2632 (C) (2)) <br /> f7ilZ�l�Gf �/ 13. PERFORMANCE TEST OF COl(TIMlX= MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br /> Gj ( 14. PERFORMANCE TEST OF LIME LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> 1 R' p 16. BALL FLOAT VALVES INSTALLED <br /> (CCR 2635 (B) (6)) <br /> 17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635-(E) (2)) <br /> 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> I 0 19. TANK INTEGRITY TEST (PASSING HARD COPT) (CCR 2635 (A) (5)) <br /> J2p q ✓ 20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br /> /( 21. •C• FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br /> 9 / 22. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2646) <br /> ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br /> M94EHTS: <br /> EH23-006 3/92 (REVISED 11\92) <br />