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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: 0 S ADDRESS: <br />FACILITY ID# TANK* UL; TANK MODEL/MATERIAL:�� <br />CAPACITY: ' PRODUCT. .E.H.S: , <br />A I <br />P N ALL TANKS TO 3E INSTALLED AND TESTED IN ACCORDANCE <br />P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />R T <br />0 I <br />ITEM OR EQUIPMENT INSPECTED LGATE <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />7_ 4�? ✓ <br />-q <br />r <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />PRIMARY PIPING TEST (MINIMUM 40 PSI /30 MIN) a <br />(CCR <br />VACUUM: PSI: HRS/MIN: SRINE(LIQUIO ANNULAR): OTHER: <br />(e)) <br />(CCR <br />(CCR <br />2643 (c) (1)) <br />2636 (9)) <br />PRIMARY TANK TEST: _5 �5 / PSI: HRS/MIN: J <br />OTHER: a CCR <br />2636 <br />(e)) <br />TANK APPROPRIATELY PLACED WITH APPROVED 3ACKFILL �, (API/PEI) <br />rr. <br />PIPING INSPECTIONS <br />` <br />l o <br />-q <br />r <br />ff <br />PRIMARY PIPING TEST (MINIMUM 40 PSI /30 MIN) a <br />(CCR <br />2636 <br />(e)) <br />(CCR <br />(CCR <br />2643 (c) (1)) <br />2636 (9)) <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: <br />OTHER: a CCR <br />2636 <br />(e)) <br />i� <br />I <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM)- - HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />(b) (2)) <br />6-w9. - <br />9. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND.WATERTIGHT). <br />API <br />�07-% <br />0. <br />v1 <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />(a) (S)) <br />V1 <br />�( <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />7 <br />(CCR <br />2635 <br />1. ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />(CCR 2630-2636) <br />(H+S CODE 25284) <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />6-1 6- � %° <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) rLS 3 5 O (CCR 2632 <br />(C) (2)) <br />(c) (2)) <br />4 <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR <br />(CCR <br />2643 (c) (1)) <br />2636 (9)) <br />17. <br />BALL FLOAT VALVES INSTALLED �Q-� 5-f j�! o <br />re <br />Ifflbl <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />C R <br />2635 <br />(b) (2)) <br />6-w9. - <br />9. <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND.WATERTIGHT). <br />API <br />��-'/ <br />0. <br />TANK INTEGRITY TEST (PASSING HARD COPY) 'a ✓hla . ( <br />i.cJ <br />(CCR <br />2635 <br />(a) (S)) <br />V1 <br />1. <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR <br />2632 <br />(d)) <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR <br />2635 <br />(d)) <br />4. <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(CCR 2630-2636) <br />(H+S CODE 25284) <br />To.V i <br />LL <br />It. 9/95 <br />10 <br />