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FACILITY NAME: �(/(� $(-oP -7% <br />FACILITY ID# TANK# <br />CAPACITY: ('�' L pn/ <br />A I <br />P N <br />P I <br />R T <br />0 I <br />V A <br />E L <br />D S <br />DATE <br />NEW UST INSTALLATION INSPECTION RECORD <br />ADDRESS: 1030 S. c <br />UL# <br />PRODUCT: <br />Lin -IF *tl L 5z®c1ctoti -. <br />TANK MODEL/MATERIAL: <br />R.E.H.S: <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />ITEM OR EQUIPMENT INSPECTED <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />m <br />PIPING INSPECTIONS <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br />7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br />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 />12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />COMMENTS _- <br />EN23-006 7/97 <br />lu <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 />15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br />16. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2636 (g)) <br />17. BALL FLOAT VALVES INSTALLED <br />18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br />20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br />22. "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br />23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br />24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br />COMMENTS _- <br />EN23-006 7/97 <br />lu <br />