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r <br />NEW UST&STALLATdON INSPECTION RE <br />_Wrt <br />FACILITY NAME: A4 V/ ADORE=: , <br />G'V ®D <br />SSEEPS9 TAllX2` ULS 3013 6cl TANK MMEiJMATERRL L: a/<_ <br />CJIPACm: �� PRODUCT: R_E-11.58 <br />v <br />$(ff l -f ✓U_ <br />A <br />I <br />HOLIDAY: <br />SECOmARY PIPING ccurAmew TEST PSI: asAw.a OTHER: <br />P <br />Y <br />ALL TAMM TO BE INSTALLED AND TESTED IN ACOORDANOE <br />P <br />I <br />WITH MAAUFACIUREt WRITTEN SPECIFICATICMS <br />5. <br />R <br />T <br />CCR Z635 (A) (41) <br />I� <br />0 <br />I <br />16. BALL FLOAT VALVES INSTALLED (CCZ 2635 (S) (6)) <br />V <br />A <br />I17. OVERFILL PROTECTION UMSYALLEDJ (CCZ 2635 (E) (2)) <br />E <br />L <br />18. TANK ACCESS PORTS BROUGNT To GRADE CLOCUO3M AND WATERTIGHT) (CCR Z631 (D) (5)) <br />0 <br />S <br />19. TANK INTEGRITY TEST (PASSING HARD COPT) CCC2 2635 (A) (5)) <br />ITEM OR EQUIPMENT INSPECTED <br />GATE <br />21- 'C" FORM COMPLETED AND SUBMITTED CCSR 2635 (E)) <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) C8) <br />2_ UST' INSTALLATION PLANS APPRC40 (CCR 2635 CE) (5)) <br />$(ff l -f ✓U_ <br />3. <br />INSPECTIpi AHO TEST OF SECOmARY CONTAIiOENT: <br />HOLIDAY: <br />SECOmARY PIPING ccurAmew TEST PSI: asAw.a OTHER: <br />VACUUM: SOAP: PSI: HRS/MIN: <br />BRIME(LIQUID ANNULAR): CYBER: <br />8- LAKE TEST ON ALL SUPS (24 HR_ MINIMUM) HRS: Z <br />PRIMARY TANK TEST: PSI: S 3/f <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />5. <br />TANK APPROPRIATELT PLACED WITH APPRMED BACKFILL <br />(CCR 2635 (A) (3) (4) W/ APT 1) <br />PIPING INSPECTIONS <br />/ <br />6- PRIMARY PIPING TEST CUNT" 40 PS1J30 MIN),f;p �/ � / <br />CC= Z635 (B) (4)) <br />/ <br />SECOmARY PIPING ccurAmew TEST PSI: asAw.a OTHER: <br />(CCR 2635 (A) (4)) <br />3 I <br />8- LAKE TEST ON ALL SUPS (24 HR_ MINIMUM) HRS: Z <br />(CCR 2635 CA)) <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br /><CC2 Z635) <br />10. OVERSPILL PERFORMANCE TEST <br />CCR Z635 (A) (41) <br />I� <br />11. ALL PIPING AND FITTINGS CORROSION PRDrmmm <br />(CC2 Z635 (B)) <br />FINAL INSPECTION <br />CC141ENTS: ' ' ®�9Y, �1 c/py i-haff-4,s( 4Py`Ti <br />Post -it Fax Note <br />To <br />v <br />EIi23-306 3/42 (REVISED 11\92) Co./Dept. <br />Phone # <br />7671 1Date��Ipaooe." 1 <br />From <br />Co. I}4jr' !✓ <br />Phone #(-,\\ X68®p 5— aj <br />Fax #�2 gytl el, _01_5F <br />12_ PERFORMANCE TEST FOR 'ALL• MONITORING PROBES (CCR 2632 (C) (2)) <br />13. PERFORMANCE TEST OF CXTIMUOUS MONITORING SYSTEN CPANEL) CCCR 2632 (A) (2)) <br />U. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (3) CS)) <br />15. PERFORMANCE TEST OF AUTCIMATIC PUMP STSTEI SHUT-OFF (CCR 26635 (S) (5)) <br />16. BALL FLOAT VALVES INSTALLED (CCZ 2635 (S) (6)) <br />I17. OVERFILL PROTECTION UMSYALLEDJ (CCZ 2635 (E) (2)) <br />18. TANK ACCESS PORTS BROUGNT To GRADE CLOCUO3M AND WATERTIGHT) (CCR Z631 (D) (5)) <br />19. TANK INTEGRITY TEST (PASSING HARD COPT) CCC2 2635 (A) (5)) <br />20. MONITORING PLAN, RESPCMM PLAN AND LOG BOOK ON SITE (CCR 2632 (E) (1) (2)) <br />21- 'C" FORM COMPLETED AND SUBMITTED CCSR 2635 (E)) <br />22_ MONITORING METHCO FOR ALL TANKS AND PIPING APPROVED (CCR Z641-2644) <br />23- ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) CF)) <br />CC141ENTS: ' ' ®�9Y, �1 c/py i-haff-4,s( 4Py`Ti <br />Post -it Fax Note <br />To <br />v <br />EIi23-306 3/42 (REVISED 11\92) Co./Dept. <br />Phone # <br />7671 1Date��Ipaooe." 1 <br />From <br />Co. I}4jr' !✓ <br />Phone #(-,\\ X68®p 5— aj <br />Fax #�2 gytl el, _01_5F <br />