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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ii_ p ADDRESS: <br /> PR# = TANK# UL# TANK MODEUMATERIAL: ►�' `�' �: <br /> COMPARTMENTALIZED TANK? (If yes, complete one form for each tank)`�J&ES [] NO <br /> 2-2,Doc ILl 000 — 87 <br /> TANK CAPACITY: 9 PRODUCT: 5,poo `11 <br /> Cts arYn�.�-n.� <br /> DATE A INITIALS <br /> P <br /> R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> ° SPECIFICATIONS <br /> E <br /> D <br /> c 1. UST PLANS SUBMITTED AND FEES PAID (H&S CODE SECTION 25287 <br /> "77i-of. 2. UST INSTALLATION PLANS APROVED <br /> INITIAL INSPECTIONS <br /> j� 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY TEST: VACUUM: 17 <br /> p ✓ v"^ ' SOAP: PSI: HRS/MIN: BRINE LIQUID ANNULAR): OTHER: <br /> 03 4. PRIMARY TANK TEST: ? <br /> -7 Dltk 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL API/PEI <br /> PIPING INSPECTIONS <br /> 3 6. PRIMARY PIPING TEST MINIMUM 40 PSI/30 MIN D 164 Ln v CCR 2636 e <br /> r v 7. SECONDARY PIPING CONTAINMENT TEST: PSI:75 H S/MIN: ' OTHER: CCR 2636 e <br /> 8. LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: CCR 2635 a 4 <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10. OVERSPILL PERFORMANCE TEST ICCR 2635 b 1 C <br /> 11.ALL PIPING AND FITTINGS CORROSION PROTECTED fCCR 2636(b) <br /> Gh1 - 12. PIPING SLOPES TO COLLECTION SUMP CCR 2636(c 1 <br /> FINAL INSPECTION <br /> 13. PERFORMANCE TEST FOR"ALL" MONITORING PROBES FCCR 2632(c)(2)1- <br /> 14. <br /> 632 c 214. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM FCCR 2632 c 2 <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION CCR 2643 c 1 <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF CCR 2636 <br /> 17. BALL FLOAT VALVES INSTALLED <br /> 18. OVERFILL PROTECTION INSTALLED AND APPROVED CCR 2r-25(b)(2)1 <br /> 19. TANK ACCESS PORTS BROUGHT TO GRADE LOCKED AND WATERTIGHT API <br /> 20. TANK INTEGRITY TEST PERFORMED HARD COPY SUBMITTED CCR 2635 a 5 <br /> 21. MONITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE rrrp 2632 d <br /> 22."C" FORM COMPLETED AND SUBMITTED CCR 2635 d <br /> 23. 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 3/18/02 <br /> 10 <br />