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NEN UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: ADDRESS: Cy y� e <br /> =w <br /> FACILITY ID# TANK# UL#/v/_a; op Z,-? TANK MODEL/MATERIAL: �6� ��- <br /> CAPACITY: PRODUCT: 5� s- R.E.H.S: <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 /> D S <br /> ITEM OR EQUIPMENT INSPECTED <br /> DATE <br /> 1. USS PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> 7 , n UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM:Z.0 SOAP: PSI: ry HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: r77Y/ PSI: HR INt� fo <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br /> gyj ` 7. SECONDARY PIPING CONTAINMENT TEST PSI:LJ NRS/ OTHER: (CCR 2636 (e)) <br /> !(� ® 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br /> ® 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> 1. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> E 3. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> m eft <br /> ® 15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> r�6 16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br /> c <br /> 17. BALL FLOAT VALVES INSTALLED <br /> ® 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> o2o. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> G�tL`Cl 1. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> 22. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> ✓ 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> V 24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23-006 7/97 �ti/� ` v <br /> Q 10 <br />