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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ,. ADDRESS: / r <br />FACILITY ID# TANK# UL# 5D`OqTANK MODEL/MATERIAL: °7 W5 <br />CAPACITY: PRODUCT: , 0 e R . E . H . S : v <br />A I <br />P N <br />P i <br />R T <br />0 I <br />V A <br />E L <br />D S <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />® <br />3. <br />INSPECTION AND TEST <br />OF SECONDARY CONTAINMENT: HOLIDAY: <br />(CCR <br />VACUUM:®. w P: <br />PSI: HR BRINE(IIQUID ANNULAR): OTHER: <br />/a v <br />4. <br />PRIMARY TANK TEST: <br />PSI: HRS/MIN: <br />E <br />(CCR <br />5. <br />TANK APPROPRIATELY <br />PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />® <br />E413. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) J56d <br />(CCR <br />(CCR <br />2636 <br />(e)) <br />�' <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS <br />OTHER: <br />(CCR <br />2636 <br />(e)) <br />1 <br />t0o5jr8. <br />(CCR <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM)'• <br />HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />t <br />(CCR <br />«-- 9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />17. <br />BALL FLOAT VALVES INSTALLED <br />10. <br />OVERSPILL PERFORMANCE TEST <br />�✓ <br />(CCR <br />2635 <br />(b) (1) (C)) <br />/®'11. <br />(b) (2)) <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />19. <br />(CCR <br />2636 <br />(b)) <br />X12. <br />PIPING SLOPES TO COLLECTION SUMP <br />TANK INTEGRITY TEST (PASSING HARD COPY) <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />COMMENTS: �� ry % <br />EH23-006 9/95 <br />10 <br />E413. <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 16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />2636 <br />(g)) <br />17. <br />BALL FLOAT VALVES INSTALLED <br />�✓ <br />8. <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) (2)) <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 />1/10-f121. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BODK ON SITE <br />(CCR <br />2632 <br />(d)) <br />` 22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR <br />2635 <br />(d)) <br />�( 23. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR <br />2630-2636) <br />124. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S <br />CODE <br />25284) <br />COMMENTS: �� ry % <br />EH23-006 9/95 <br />10 <br />