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NtW USI INSTALLATION INJi'tW lUN KtLUKU <br />FACILITY NAME: (J ! ADDRESS: Ttoz _ S <br />FACILITY ID# TANK# UL,*TANK MODEL/MATERIAL: <br />CAPACITY:% ,� �i/'i/7 PRODUCT: Si.A,7j_,, ,,, D %/ . l _ R.E.H.S: �D_ .:. /•f, <br />INITIAL INSPECTIONS <br />-6. <br />1 <br />A <br />I <br />HOLIDAY: <br />(e)) <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />BRINE(LIQUIO ANNULAR): OTHER: <br />P <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />PRIMARY TANK TEST: A i r <br />R <br />T <br />�- ti <br />✓` <br />0 <br />V <br />I <br />A <br />WITH APPROVED BACKFILL <br />(API/PEI) <br />E <br />L <br />2635 <br />(b) (1) (C)) <br />0 <br />S <br />(CCR <br />2636 <br />(b)) <br />"I ✓ I <br />711 2}?& <br />(CCR <br />2636 <br />(c)(1)) <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2630-2636) <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25281) <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />-6. <br />1 <br />77 ,. 3. <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />HOLIDAY: <br />(e)) <br />�I <br />VACUUM: SOAP: �4j <br />PSI: ,j 5 HRS/MIN: <br />BRINE(LIQUIO ANNULAR): OTHER: <br />-, <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />KP <br />PRIMARY TANK TEST: A i r <br />PSI: -5 <br />HRS/MIN: -30 <br />�- ti <br />✓` <br />PEI <br />TANK APPROPRIATELY PLACED <br />WITH APPROVED BACKFILL <br />(API/PEI) <br />PIPING INSPECTIONS <br />4/-4 b 4 h PM- <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />(CCR <br />2636 <br />(e)) <br />�I <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: <br />(CCR <br />2636 <br />(e)) <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM)- HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />s <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />BALL' FLOAT VALVES INSTALLED roof i� 16 $ 'f '�,(�Jp� j� SCC Q <br />�`� c -L <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />1f <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />"I ✓ I <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />%/ r <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />(CCR 2632 CC) (2))7,51 "I <br />.alb- <br />IA <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />CCCR 2632 (c) (2)) <br />_f 1 <br />lI <br />P/ <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />(CCR 2643 (c) (1)) <br />Q <br />�PERFORMANCE <br />TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR 2636 (rg)3 <br />17. <br />BALL' FLOAT VALVES INSTALLED roof i� 16 $ 'f '�,(�Jp� j� SCC Q <br />�`� c -L <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />(CCR 2635 (b) (2)) <br />Q <br />- <br />TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND•WATERTIGHT). <br />API <br />ld <br />Ii <br />TANK INTEGRITY TEST (PASSING HARD COPY) fpm <br />(CCR 2635 (a) (5)) <br />Ljkv <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR 2632 (d)) <br />(CCR 2635 (d)) <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2630-2636) <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S CODE 25284) <br />COMMENTS:— <br />EH23-006 9/95 <br />10 <br />