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NEW UST iNSTALLATION RECORD I n� T A4 <br /> ' <br /> FACILITY NAME Vdiole' V <br /> FACILITY ADDRESS COIR Iy M bLaroac r / Id) l V e ) <br /> SWEEPS # v TANK# 1 U.L. # j 1 PRODUCT <br /> DATE APPROVED DISAPPROVED RENS ITEM OR EQUIPMENT INSPECTED <br /> �q I2 I 1. UST INSTALLATION PLANS SUBMITTED & FEES PAID <br /> 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTION <br /> 1. HOLIDAY TEST (PLASTEEL) <br /> 2. AIR TESTED @ 5 PSI (FRP) <br /> l3 / 3. VISUAL INSPECTION OF 20 CONTAINMENT <br /> 4. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br /> PIPING STAGE INSPECTION <br /> V <br /> 0��j 1. PRESSURE TEST [1 AND 2 (NFPA 30)] <br /> f v_r 2. BALL FLOAT VALVES INSTALLED / <br /> Y V+ 3. OVERFILL PROTECTION INSTALLED, DESCRIBE: qr� OYY�¢C-O <br /> 4. UNUSED TANK OPENING SEALED & CATHODICALLY PROTECTED <br /> S. VISUAL INSPECTION OF 20 CONTAINMENT ON PIPING <br /> 'I 6. MONITORING PORTS IN PLACE & BROUGHT TO GRADE (LOCKABL.E <br /> iv J A WEATHER PROOF COVERS) <br /> 7. FILL &VENT PIPING BROUGHT TO GRADE <br /> 8. PRODUCT LINE LEAK DETECTOR INPLACE (HARD WIRED) <br /> 9. APPROVED UST LEAK MONITORING DEVICE INSTALLED W'A oA"i5. <br /> 10. ALL GALVANIZED PIPING & FITTINGS PROPERLY WRAPPED( <br /> 11. PRESSURE DECAY TEST ON COMPLETE UST & PRODUCT DELIVERY <br /> SYSTEM <br /> FINAL INSPECTION <br /> 11 1. PRECISION TEST SUCCESSFULLY COMPLETED AND HARD COPIES <br /> 1, V <br /> RECEIVED (NEPA 329) <br /> 2. SPILL PROTECTION AT FILL PIPE <br /> 3. PERFORIviANCE TEST OF OVERFILL PROTECTION SYSTEM <br /> 4. PERFORMANCE TEST OF PRODUCT LINE LEAK DETECTOR (HARD <br /> WIRED) <br /> /Zq1#1 / 5. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM(S) ON <br /> �� V TANK(S) <br /> I G�2 ✓ 6. PERMIT TO OPERATE APPLICATION COMPLETE <br /> 7. ACCEPTABLE RECORD KEEPING SYSTEM <br /> Eli 23 006 (R.EV 4- <br />