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NEW UONSTALLATiON INSPECTION REORD <br /> FACILITY MAKE: 5•41Z. (� ADDRESS: 2,OI V'✓ /1iLr`lti <br /> SLEEPSf TANX# ULA TANK MODEL/MATERIAL:�y,� S+, <br /> CAPACITY: 1 1 PRODUCT: <br /> A I <br /> P MALL TAMCS TO BE INSTALLED ADD 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, CCA 2635 (D) C8) <br /> f� _C�S ✓ f` 2. UST INSTALLATION PLANS APPROVED (CCR 2635 CE) (5)) <br /> INITIAL INSPECTIONS <br /> 1�J'3 Cid ✓ K 3. INSPECTION Am TEST OF SECONDARY CONTAIMMEN•T: HOLIDAY: <br /> VACUUM: SOAP: PSI: MRS/MIM: BRIMECLIOUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIM: <br /> ��_ �� ✓ 5. TANK APPROPRIATELY PLACED WITH APPROVE) BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> 9s K 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIM) (CCR 2635 (8) (4)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST pSI:Z lj2HRSA OTHER: CCCR 2635 (A) (4)) <br /> ll- - S ✓ L <br /> S. LAKE TEST ON ALL SUPS (24 HR. MINIMUM) MRS: (Cat 2635 (A)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (Cat 2635) <br /> l�7�j S ✓ 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> l/2-z6-q S ✓ .I 12. PERFORMANCE TEST FOR -ALL- MONITORING PROBES (CCR 2632 (C) (2)) <br /> l,,N6-q 13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 CA) (2)) <br /> �z-zo_( S 14. PERFORMANCE TEST OF LINE LEAK DETECTION (Cat 2432 (D) 2635 (B) (5)) <br /> 12 Z U AS 15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (8) (5)) <br /> (Z_&-(- ✓ 16. BALL FLOAT VALVES INSTALLED (CCR 2635 CB) (6)) <br /> /z'zo"may 117. OVERFILL PROTECTION INSTALLED/APPROVED CCCR 2635 (E) (2)) <br /> /� ✓ 18. TANK ACCESS PORTS BROUGHT TO GRADE CLOCKED ADD WATERTIGHT) C= 2631 (D) (5)) <br /> , -C7 19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) CS)) <br /> (Z_ZC_CSS• ✓ �.1 20. MONITORING PLAN, RESPONSE PLAN ADD 'LOG BOOK ON SITE (CCR 2632 (E) Cl) C2)) <br /> ��-L�/ ✓ 21. •C' FORM CDPLETED ADD SUBMITTED (CCR 2635 (E)) <br /> 22. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED CCCR 2641-2644) <br /> z 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br /> COMMENTS. <br /> EH23-006 3/92 (REVISED 11\92) <br /> 8 <br />