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NEST UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: y, f j " ADDRESS: <br />FACILITY ID# 0 _; ', TANKS " I UL* ' TANK MODEL/MATERIAL: JOOR f -J Int <br />CAPACITY: % 49, 496 PRODUCT: 4 R.E.H.S: ® < 1/a <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 />0 S <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />t. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 2528 <br />UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS PS. <br />6+� <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />HOLIDAY: <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />VACUUM:15k - SOAP: PSI: HRS/MIN: <br />BRINE(LIQUID ANNULAR): OTHER: <br />f <br />// <br />4. PRIMARY TAW TEST: �s I'.�C PSI: <br />HRS/MIN: <br />SECONDARY PIPING CONTAINMENT TEST PSI: <br />5. TANK APPROPRIATELY PLACd WITH APPROVED BACKFILL <br />(API/PEI) <br />PIPING INSPECTIONS <br />r <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />/- A <br />(CCR 2636 (e)) <br />f <br />// <br />(CCR 2632 (c) (2)) <br />SECONDARY PIPING CONTAINMENT TEST PSI: <br />HRS/Ml: OTHER: <br />(CCR 2636 (e)) <br />® <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM STRUT -OFF <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) <br />HRS: <br />(CCR 2635 (a) (4)) <br />-1 Y t� <br />UNUSED TANK OPENINGS AND ION PROTECTED?Tr <br />PEI <br />I <br />(CCR 205 (b) (2)) <br />OVERSPILL PERFORK49M TEST <br />TANK ACCESS PORTS ROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />(CCR 2535 (b) (1) (C)) <br />I 11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />f <br />CCS 2636 (b)) <br />MONITORING PLAN, RESPONSE PLAN AND LOG 300K ON SITE <br />(CCA 2632 (d)) <br />2. <br />PIPING SLOPES TO COLLECTION STRIP <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />COMMENTS: <br />EH23-006 9/95 T <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br /><CCII 2632 (c) (2)) <br />/- A <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (c) (2)) <br />_PERFORMANCE <br />TEST OF LlHE LEAK DETECTItNN 6' ; .5 ' v : <br />(CCA 2643 (c) (t)) <br />® <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM STRUT -OFF <br />(CCR 2636 (9)) <br />7. <br />BALL FLOAT VALVES INSTALLED <br />® <br />I <br />OVERFILL PROTECTION INSTALLED/ <br />(CCR 205 (b) (2)) <br />TANK ACCESS PORTS ROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />APT <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />CCCR 2635 (a) (5)) <br />MONITORING PLAN, RESPONSE PLAN AND LOG 300K ON SITE <br />(CCA 2632 (d)) <br />:22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR 2635 (d)) <br />.y <br />IMONITORING <br />METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2630-2636) <br />(24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(N+S CODE 25284) <br />COMMENTS: <br />EH23-006 9/95 T <br />