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Ink NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ADDRESS; j <br />FACILITY ID# TANK# UL#to4-m TANK MODEL/MATERIAL: <br />CAPACITY: PRODUCT: `/j R.E.H.S <br />INITIAL INSPECTIONS <br />A <br />I <br />OF SECONDARY CONTAINMENT: HOLIDAY: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />4. PRIMARY TANK TEST: <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />PLACED WITH APPROVED BACKFILL (API/PEI) <br />R <br />T <br />(e)) <br />0 <br />I <br />j <br />HRS: <br />V <br />A <br />j <br />E <br />L <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />D <br />S <br />(g)) <br />® <br />10. <br />OVERSPILL PERFORMANCE TEST <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />2635 <br />(b) (1) (C)) <br />( <br />1. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />(CCR <br />2636 <br />(b)) <br />UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />3. INSPECTION AND TEST <br />OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM!?A SOAP: <br />PSI: HRS/8W 3x, BRINE(LIQUID ANNULAR): OTHER: <br />(e)) <br />4. PRIMARY TANK TEST: <br />PSI: HRS/MIN: <br />i <br />5. TANK APPROPRIATELY <br />PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />(CCR <br />2636 <br />(e)) <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI: '71 <br />HRS/ I OTHER: <br />(CCR <br />2636 <br />(e)) <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM)', <br />HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />..,. �— <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />(CCR <br />2636 <br />(g)) <br />® <br />10. <br />OVERSPILL PERFORMANCE TEST <br />17. <br />(CCR <br />2635 <br />(b) (1) (C)) <br />( <br />1. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />18. <br />(CCR <br />2636 <br />(b)) <br />7® <br />® <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />19. <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />COMMENTS:—a'7// <br />x}123-006 9/95 <br />T <br />R 10 <br />13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />(c) (2)) <br />14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />2632 <br />(c) (2)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR <br />2643 <br />(c) (1)) <br />f <br />16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />2636 <br />(g)) <br />f <br />17. <br />BALL FLOAT VALVES INSTALLED <br />(Z� <br />18. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) (2)) <br />,fi4wly <br />1 <br />19. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) <br />API <br />20. <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2635 <br />(a) (5)) <br />21. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR <br />2632 <br />(d)) <br />22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR <br />2635 <br />(d)) <br />P <br />23. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR <br />2630-2636) <br />24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S <br />CODE <br />25284) <br />COMMENTS:—a'7// <br />x}123-006 9/95 <br />T <br />R 10 <br />