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\ NEY UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: .y A\ " ADDRESS: \ S yLi <br />FACILITY ID# i90 TANK# 0'-50-7 / ? 'yL -*5 UL#PlW! TANK NaDEL/NATERIAL: t?L I la <br />CAPACITY: Q� PRODUCT: , R.E.H.S: 1 �, <br />INITIAL INSPECTIONS <br />!vc <br />A <br />P <br />I <br />N <br />ALL TANKS TO SE INSTALLED AND TESTED IN ACCORDANCE <br />®._ <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />/2-2- <br />R <br />T <br />ary <br />HRS/MIN: 3�^�ki�-. <br />0 <br />1 <br />PEI <br />TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />V <br />A <br />(CCR 2635 (b) (1) (C)) <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />E <br />LA <br />tilt <br />oLs- �� I <br />12. PIPING SLOPES TO COLLECTION SUMP <br />(CCR 2636 (c)(1)) <br />(CCR 2635 (a) (5)) <br />eJ' <br />I <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />CCCR 2632 (d)) <br />I 22. <br />ITEM OR EQUIPMENT INSPECTED <br />DATE-3aft <br />Q I <br />UI <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />'q, Ip <br />I I24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />t. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />!vc <br />3. <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />HOLIDAY: <br />®._ <br />/541: <br />t- ,SOAP: PSI: HRS/MIN: <br />BRINE(LIGUID ANNULAR): OTHER: <br />/2-2- <br />8. LAID: TEST ON ALL SUMPS (24 HR. MINIMUM) <br />4. <br />PRIMARY TANK TEST: �6hiy VACu-Wn PSI: <br />HRS/MIN: 3�^�ki�-. <br />9. UNUSED TANK OPENINGS SEALED AUG CORROSION PROTECTED <br />_ C <br />PEI <br />TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />eC4," (API/PEI) <br />PIPING INSPECTIONS <br />a» _ <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 NIN) Sipsj <br />13 e <br />(CCR 2636 (e)) <br />®._ <br />SECONDARY PIPING CONTAINMENT TEST PSI: S HRS/NIN: <br />' OTHER: <br />(CCR 2636 (e)) <br />PERFORMANCE TEST OF LINE LEAK DETECTION G` If - <br />8. LAID: TEST ON ALL SUMPS (24 HR. MINIMUM) <br />NRS: O)Y► <br />(CCR 2635 (a) (4)) <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF S� � <br />9. UNUSED TANK OPENINGS SEALED AUG CORROSION PROTECTED <br />_ C <br />PEI <br />lj ✓ <br />OVERSPILL PERFORMANCE TEST <br />(CCR 2635 (b) (1) (C)) <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />11. ALL PIPING AND FITTINGS CORROSION PROTECTED ��'�j1/,c <br />�i S,S', <br />(CCR 2636 (b)) <br />oLs- �� I <br />12. PIPING SLOPES TO COLLECTION SUMP <br />(CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />�v <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR 2632 (c) (2)) <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (c) (2)) <br />' <br />rr+ <br />PERFORMANCE TEST OF LINE LEAK DETECTION G` If - <br />(CCR 2643 (c) (1)) <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF S� � <br />Ff(h Z636 (4)) <br />_ C <br />BALL FLOAT VALVES INSTALLED <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 2635 (b) (2)) <br />I/ I <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR 2635 (a) (5)) <br />eJ' <br />I <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />CCCR 2632 (d)) <br />I 22. <br />"C' FORM COMPLETED AND SUBMITTED <br />(CCR 2635 (d)) <br />Q I <br />UI <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(OCR 2630-2636) <br />I I24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S CODE 25284) <br />COMMENTS: <br />EH23-306 9/95 T <br />