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MV UST INSTALLATION INSPECTIOM RECORD <br />FACILITY NAME: �� ADDRESS: <br />FAC:LITY 1D* TANKS UL* TANK MODEL/MATERIAL: <br />CAPACITY: PRODUCT: <br />INITIAL INSPECTIONS <br />A <br />I <br />(CCR 2636 (e)) <br />!7' GL <br />P <br />V <br />ALL TANKS TO 3E INSTALLED AND TESTED IN ACCO aM=- <br />PRIMARY TANK TEST: PST: HRS/MIN: <br />P <br />I <br />WITH MANUFAC URE WRITTEN SPECIFICATIONS <br />R <br />T <br />(C 2635 (h) (1) (C)) <br />0 <br />I <br />CC= 2636 (h)) <br />% q ! <br />V <br />A <br />CCCt 2636 (c)(1)) <br />E <br />L <br />(19. TANK ACCESS PMTS WAI MT TO GRADE (LOaM AND WATERTIGHT) API <br />0 <br />S <br />I20. TANK INTEGRITY TEST (PASSING HARD CO") (CCR 2635 (a) CS)) <br />ITEM OR EQUIPMENT INSPECTED <br />OATE <br />I22. "'C" FORM COmPt_oiED AND SUBMITTED (Cat Z635 (d)) <br />( <br />I <br />I <br />11. UST PIANS SUBMITTED/ FES PAID (H+S CCDE 25= <br />IZ4. ALL C;NOITIONS MET; FACILITY POERMIT ISSUED (H+S CODE 25284) <br />Z. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />PIPING INSPEC:IOMS <br />'1 3. <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />(CCR 2636 (e)) <br />!7' GL <br />VAGAXi I SOAP: PSI: T5- HRS/mIx: 3RINE(LIQUID ANNULAR): OTHER: <br />II <br />14. <br />PRIMARY TANK TEST: PST: HRS/MIN: <br />G��I <br />✓� S 15. <br />TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFILL (API/PEI) <br />PIPING INSPEC:IOMS <br />FINAL INSPECTION <br />I`.__,, 6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) '1 VEE <br />(CCR 2636 (e)) <br />!7' GL <br />I ✓ I 17. <br />8. <br />SECONDARY PIPING CONTAINMENT TEST PSI: NRS/MIN: OTHER: <br />LAKE TEST ON ALL 9"S (24 VR. MINIMUM) HRS: <br />CC:t 2636 (e)) <br />CC's 2635 (a) (4)) <br />9. <br />UNUSED TAUK OPENINGS SEALS AND CORROSION <br />PEI <br />(10. <br />OMSPILL PERFORMANCE TESTI <br />(C 2635 (h) (1) (C)) <br />1. <br />I <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />CC= 2636 (h)) <br />% q ! <br />12. <br />PIPING SLOES TO COLLECTION SUMP <br />CCCt 2636 (c)(1)) <br />FINAL INSPECTION <br />COMMENTS: <br />::123-106 9/95 T <br />I13. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCI 2632 (c) (2)) <br />I14. PERFORMANCE TEST OF COMTIXtJOUS )MITORING SYST$N (PANEL) (= 2632 (c) (2)) <br />I15. Mr-CRMANCE TEST OF LINE LEAK DETECTION (C=t 2643 Cc) (1)) <br />I16. PERFCRxANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF CCCR 2636 (9)) <br />17. BALL FLOAT VALVES INSTALL <br />18. OVERFILL PROTECTION INSTALLED/APPROVED LCCA 2635 (b) (2)) <br />(19. TANK ACCESS PMTS WAI MT TO GRADE (LOaM AND WATERTIGHT) API <br />II <br />I20. TANK INTEGRITY TEST (PASSING HARD CO") (CCR 2635 (a) CS)) <br />IZi. MONITORING PIAN, RESPONSE PIAN AMD LOG 3OOK ON SITE (CGT 26U (d)) <br />I22. "'C" FORM COmPt_oiED AND SUBMITTED (Cat Z635 (d)) <br />( <br />I23. MONITORING METHM FOR ALL TANKS AND PIPING APPROVED (CCR a30'26'ab) <br />IZ4. ALL C;NOITIONS MET; FACILITY POERMIT ISSUED (H+S CODE 25284) <br />COMMENTS: <br />::123-106 9/95 T <br />