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NEW LISMSTALLATION INSPECTION REI$RD <br /> FACILITY MAKE: vac c. C--,.4 . g ADDRESS: 2"10) v-1• M--r-;. <br /> SLS:EP52 TAW ULf TANG MODELJMATERIAL: <br /> CAPACITY: 1 5 PRODUCT: M v _ - ` ' R.E.H_S: <br /> A I �L <br /> P NALL TANKS TO BE INSTALLED AND TESTED IS ACLCRDAIKE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATI0NS <br /> R T <br /> O I <br /> V A <br /> E L <br /> D S <br /> ITEM OR EOUIPMENT INSPECTED <br /> DATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H+S CCOE 25287, Z05 (D) C8) <br /> U SO-CC's ,� 'K 2. LIST INSTALLATION PLANS APPROVED CCCR 2635 CE) C5)) <br /> INITIAL INSPECTIONS <br /> /0.3i_Ci S ✓ /- 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VAaXJN: SOAP: PSI: HRS/MIN: BRINECLIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: HRS/MIN: <br /> `O K 5. TANK APPROPRIATELY PLACED WITH APPROV® BACXFILL (CC+t ?1135 CA) (3) (4) (6)/ APIJPEI) <br /> PIPING IIISPELTIcus <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (C3I 2635 (S) (4)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI i7/Z HRS/te�)BoOTHER: CCCZ 2635 CA) Co) <br /> t 1-�� Q�� ✓ LI 8. LAKE TEST ON ALL SUPS C24 BR. MINIM A) HRS: C= 2635 (A)) <br /> l2- (; 4•.�� ✓ 9. IACUSID TANK OPENINGS SEALED AND CORROSION PROTECTED (CC2 2635) <br /> 1 _ c S SI✓ 10. OVERSPILL PERFORMANCE TEST C= 2635 (A) C4)) <br /> �.ZaCt ✓ 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 CB)) <br /> FINAL INSPECTION <br /> 12. PERFORMANCE TEST FOR •ALL' MONITORING PROBES (CCA 2632 CC) (2)) <br /> 1�_2�.c( ✓ Ii� 13. PERFORMANCE TEST OF MMTINt= MONITORING SYSTEM (PANEL) CCCt 2632 CA) (23) <br /> N 14. PERFORMANCE TEST OF LIKE LEAK DETECTION (CC3 2632 CD) 205 CS) (5)) <br /> �Z_'Z l7 j 15. PERFORMANCE TEST OF AUTONITIC PIMP SYSTEM SHUT-OFF CCCR Z05 (8) CS)) <br /> t2-zO'rd'l 16. BALL FLOUT VALVES INSTALLED CCCI 205 (8) (6)) <br /> Z-?()-q ✓ 17. OVERFILL PROTECTION INSTALLED/APPROVED CCCR 2535 CE) C2)) <br /> 2'zo_Ct ✓ 18. TANK ACCESS PORTS MtOUGHT TO GRADE CLt]crpD AND WATERTIGHT) CCC2 2631 CD) (5)) <br /> TANK INTEGRITY TEST (PASSING BARD COPY) (CCR 205 CA) (5)) <br /> �I20. MONITORING PLAN, RESPONSE PLAN AND LOG B= ON SITE C= 2£32 CE) Cl) C2)) <br /> -z-�� 21. -C' FORM COMPLETED AND SUBMITTED CCCR 2635 (E)) <br /> 22. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED CCCSC 2641-264.4) <br /> 23. ALL CONDITIONS NET; FACILITY PERMIT ISSUED CH+S CODE 25284 (E) CF)) <br /> COWENTS: <br /> EH23-006 3/92 (REVISEED 11\92) <br />