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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: � -' � ADDRESS: <br /> FACILITY ID# TANK# UL# TA K MODEL/MATERIAL• <br /> Lf <br /> CAPACITY: /1//<� PRODUCT: n �!' �� R.E.H.S: . jf _ <br /> A I <br /> P N ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> 0 I <br /> V A <br /> E L <br /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> �? t j 2. UST INSTALLATION PLANS APPROVED <br /> Lh <br /> INITIAL INSPECTIONS <br /> L 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: C& SOAP: PSI: HRS/ IN: ,/J BRINE(LIOUID ANNULAR): OTHER: <br /> ! Ziu 4. PRIMARY TANK TEST: PSI: HRS/ N: 3(D <br /> j �Z;nJ u 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> V-1/ 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) J�r `j (CCR 2636 (e)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br /> 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br /> �/�/ G�, ✓ J 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> 13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> 15. PERFORMANCE TEST OF LINE LEAK DETECTION �� -Gs � (CCR 2643 (c) (1)) <br /> 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF / (CCR 2636 (g)) <br /> 17. BALL FLOAT VALVES INSTALLED IVIA <br /> Z{ q (( 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> Z/Z 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> 20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> /7S �d ✓ ��22. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> r <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED 7-66 b (CCR 2630-2636) <br /> -2ht/-fid j 24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23-006 9/95 <br /> 10 <br />