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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: z ADDRESS: � <br />FACILITY ID# TANK#UL# TANK MODEL/MATERIAL: <br />CAPACITY: 1A 000PRODUCT: R.E.H.S: af <br />INITIAL INSPECTIONS <br />A <br />I <br />3. <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />PRIMARY TANK TEST: % iAlj'^"cib PSI:` HRS/MIN: <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />2636 <br />R <br />T <br />/ <br />8. <br />0 <br />I <br />(CCR <br />2635 <br />V <br />A <br />9. <br />(To <br />E <br />L <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />i <br />D <br />S <br />(T1 <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />11. <br />t <br />(CCR <br />2636 <br />(b)) <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />(CCR <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />�. PIPING INSPECTIONS <br />'` <br />3. <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />if/6176 <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUIO ANNULAR): OTHER: <br />4. <br />PRIMARY TANK TEST: % iAlj'^"cib PSI:` HRS/MIN: <br />7. <br />TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />�. PIPING INSPECTIONS <br />'` <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />(CCR <br />2636 <br />(e)) <br />jj <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI: NRS/MIN: OTHER: <br />(CCR <br />2636 <br />(e)) <br />ff <br />/ <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: 1 <br />I <br />(CCR <br />2635 <br /><a) (4)) <br />lIilvw <br />f <br />9. <br />(To <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />i <br />2636 <br />(g)) <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />l <br />(CCR <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />COMMENTS:— <br />EH23-006 9/95 <br />ul <br />PF <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR <br />2632 <br />(C) <br />(2)) <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR <br />2632 <br />(c) <br />(2)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR <br />2643 <br />(c) <br />(1)) <br />I A <br />e <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />2636 <br />(g)) <br />17. <br />BALL FLOAT VALVES INSTALLED <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR <br />2635 <br />(b) <br />(2)) <br />4r <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND,WATERTIGHT). <br />API <br />TANK INTEGRITY TEST (PASSING HARD COPY)(CCR <br />2635 <br />(a) <br />(5)) <br />21. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR <br />2632 <br />(d)) <br />22. <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR <br />2635 <br />(d)) <br />23. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR <br />2630-2636) <br />24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S <br />CODE <br />25284) <br />COMMENTS:— <br />EH23-006 9/95 <br />ul <br />PF <br />