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NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: /aj ADDRESS: ep <br /> FACILITY ID# TANK# UL# TANK MODEL/MATERIAL: <br /> CAPACITY: / a PRODUCT: R.E.H.S: I <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. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 7f 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: u y� �,aPSI: HR /MI <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> 6 <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) ® ® Tj p (CCR 2636 (e)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: G] HRS/9=5-c.. OTHER: (CCR 2636 (e)) <br /> ® � �y 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 /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> I <br /> b c 1 <br /> 12. <br /> PIPING SLOPES TO COLLECTION SNIP <br /> CCR 263 ( )( )) <br /> FINAL INSPECTION <br /> t <br /> p <br /> 13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> oes ® 15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br /> f / <br /> 6. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br /> ® 7. BALL FLOAT VALVES INSTALLED <br /> 18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> �D 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> 20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> 61121- MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> g 0 ✓ 22. --Cl- FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> 4. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> EH23-006 7/97 <br /> 10 <br />