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IVCVV UJ ' 'NJ I NLLA I IUN IN%blJt(; I IUN Ht( '-JI] <br /> .ITY NAME: ���+.>11 ADDRESS: <br /> :f PS/ l9y v//77^�r99 TAIIKiY <br /> ULf TANK MODEL/HATERIAL: <br /> CAPACITY: /0 !� PRODUCT: <br /> JE <br /> ALL TANKS TO BE INSTALLED AMD TESTED IN ACCORDANCE <br /> WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> DAT <br /> ITEM OR EQUIPMENT INSPECTED <br /> �Z1. UST PLANS S18MITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> UST INSTALLATION PLANS APPROVED 4L1 (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS �!! <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> /1� A VACUUM: SOAP: PSI: HRS/MIM: BRINE(LIOUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIM: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ AP[/PEI) <br /> PIPING INSPECTIONS <br /> �( ✓ 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCA 2635 (B) (4)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI:ZG HRS/MIN-/11C THER: (CCR 2635 (A) (4)) <br /> Dom/ <br /> LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: Z (CCR 2635 (A)) <br /> /Z�qAll9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> GL ✓ iT 10. OVERSPILL PERFORMANCE TEST <br /> (CCR 2635 (A) (4)) <br /> ALL PIPING AND FITTINGS CORROSION PROTECTED <br /> (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> 12. PERFORMANCE TEST FOR *ALL" MONITORING PROBES (CCR 2632 (C) (2)) <br /> ✓ 13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCA 2632 (A) (2)) <br /> o <br /> ✓ 14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br /> OVERFILL PROTECTION IMSTALLED APPROVED (CCR 2635-(E) (2)) <br /> Z918. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> f 19. TANK INTEGRITY TEST (PASSING HARD COPT) (CCR 2635 (A) (5)) <br /> 20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br /> 21. •C' FORA COMPLETED AND SBMITTED <br /> (CCR 2635 (E)) <br /> / g ! MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) <br /> �L /f ✓ / 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br /> -ZMMENTS: � 6_ 46CL � !' 0�(fr(Ql�l Irj J Z <br /> A06 3/92 (REVISED 11\92) <br /> g <br />