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NEW UST &TALLATION INSPECTION REC <br />FACILITY NAME: ADDRESS: `t <br />SWEEPS# TANK# UL# TANK NODEL/MATERIAL: I✓ <br />CAPACITY: 1 11 — e 11 PRODUCT: t it It s A J R.E.H.S: ® 1A <br />INITIAL INSPECTIONS <br />A <br />I <br />VACUUM: SOAP: I: HRS/NIN: BRINE(LIQUID ANNULAR): OTHER: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />, . <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />R <br />T <br />�!1rJ�i..,l <br />� LiSYI <br />0 <br />I <br />16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br />/ AG 141L <br />V <br />A <br />17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br />E <br />L <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br />D <br />S <br />19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />21. ®C■ FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />1 <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br />511 b <br />�/ <br />-�(� <br />2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br />INITIAL INSPECTIONS <br />PIPING INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: oef <br />VACUUM: SOAP: I: HRS/NIN: BRINE(LIQUID ANNULAR): OTHER: <br />T. SECONDARY PIPING CONTAINMENT TEST PSI:i <br />4. PRIMARY TANK TEST: PSI: 6 HRS/MIN: <br />, . <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />12. PERFORMANCE TEST FOR •ALLN MONITORING PROBES (CCR 2632 (C) (2)) <br />T. SECONDARY PIPING CONTAINMENT TEST PSI:i <br />m,,�1� <br />, . <br />14. PERFORMANCE TEST OF LINK: LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br />�!1rJ�i..,l <br />� LiSYI <br />. �i. h. ♦� . .. �. • .. / �i YY' t. p <br />FINAL INSPECTION <br />COMMENTS: <br />EH23-006 3/92 (REVISED 11\92) <br />8 <br />12. PERFORMANCE TEST FOR •ALLN MONITORING PROBES (CCR 2632 (C) (2)) <br />13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (A) (2)) <br />14. PERFORMANCE TEST OF LINK: LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br />15. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br />M <br />16. BALL FLOAT VALVES INSTALLED (CCR 2635 (B) (6)) <br />/ AG 141L <br />17. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (E) (2)) <br />18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br />19. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (A) (5)) <br />20. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCA 2632 (E) (1) (2)) <br />21. ®C■ FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br />1 <br />22, MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) <br />511 b <br />�/ <br />-�(� <br />23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25264 (E) (F)) <br />COMMENTS: <br />EH23-006 3/92 (REVISED 11\92) <br />8 <br />