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11 n u n u I 1 0 :l [1 0 H 0 AC A c�ua� �cAa YETI NO N/A ❑ ❑ ❑ 1. APPROVED C.PA PERMIT W/ SIGN OF. Y0: ND N/A ❑ ❑ ❑ 1. CALIFORNIA STATE CONTRACTORS UCEM ❑ ❑ ❑ 2 APPROVED FIRE DEPARTMENT PERMIT W/ SIGN OFF. ❑ ❑ ❑ 2.URRRENNT)CC (CU❑ 24 T IKSTMNTHAU TION/V�, ❑ ❑ 3. APPROVED BUILOING PERMIT PITH SIGN OFF. .❑ ❑ ❑ 3. CURRENT KX1 TANK REMOVAL CERTIFHC ❑ ❑ ❑ 4. ADDITIONAL PERMITS REOUIRED W/ SIGN OFF. E] E]4. CMFWS URRENT TANK MDATIO COTUR ❑ ❑ 13 & AQMD (ATC). 36 MONTH ❑ ❑ ❑ 6. U.S.A. EXCAVATION PERMIT NO. ❑ ❑ ❑ 5. CURRENT PIPE MANUFACTURER'S INSTAL ❑ ❑ ❑ MOP. 7. AT&T MOP. ❑ ❑ ❑ MFG'S RECDMMENDA110N OR 36 MONTH S. VEDDER ROOT MONITORING SYSTEM TEE ❑ ❑ ❑ S. SITE HEALTH & SAFETY PIAN. (MUST BE MFG'S HIGHEST RANKING LE! ❑ ❑ ❑ 8. PROJECT SCHEDULE. ❑ ❑ ❑ 7. CONTRACTOR'S WORKMANSHIP WARRANT ❑ ❑ ❑ 10. 48 HOUR INSPECTION NOTIFICATIONS. ❑ ❑ ❑ 11. LETTER OF COI, PLETHON (REPAIRS ONLY). �� ❑ ❑ ❑ 12 FORM "C'. ❑ ❑ ❑ 13. PERMIT EXTENSIONS ❑ ❑ ❑ -14. ALL AGENCY CORRESPONDENCE/ W CON IRuATI0N5. YES NO N/A ❑ ❑ ❑ 1. POTS UNE ORDER & SERVICE FORM. __. __... - ❑ ❑ ❑ 2 ALARMS TESTED AND CONFIGURED TO P TAN; AADem-mff CF.FT simm/ wAmmnm ❑ ❑ ❑ 3. WARRANTY START -TIP FORM. ❑ ❑ ❑ 4. OA/OC VEEDER ROOT CONSOLE. YES Nn N/A ❑ ❑ ❑ 5. 48 HOUR INSPECTION NOTIFICATION REQ ❑ ❑ ❑ 1. TANK MANUFACTURER'S CUT SHEETS/TANK CHART. ❑ ❑ ❑ 6. SYSTEM DISCONNECT (Ems NOTIFK:ATK ❑ ❑ ❑ 2. TANK MANUF'ACTURER'S WARRANTY. ❑ ❑ ❑ 7. WARRANTY. OWNER'S. AND OPERATOR'S ❑ ❑ ❑ & COMPLETED MANUFACTURER'S INSTALLATION CHECKUST. ❑ ❑ ❑ S. MON17ORNG FUND CERTIFTCA71OhL ❑ ❑ ❑ 4. PIPING AMPS MANUFACTURER'S CUT SHEETS/WARRANTY- ❑ ❑ ❑ 9. OTHER ❑ ❑ ❑ & DAY TANK MANUFACTURER'S CUT SHEETS/ TANK CHART. ❑ ❑ ❑ S. DAY TANK MANUFACTURER'S WARRANTY. M ❑ ❑ 7. PUMPS MANUFACIUREWS CUT SHEEIS. QA/OC Ct€m ❑ ❑ ❑ & MONITORING SYSTEM MANUFACTURER'S CUT SHEETS ❑ ❑ ❑ 9. MONITORING SYSTEM MANUFACTURER'S WARRANTIES, YEs No N/A ❑ ❑ ❑ 10. HYDROSTATIC MONITORINFTI FLUID - CUT SHEETS. ❑ ❑ ❑ 1. TANK DEUVERY CHECKLIST. ❑ ❑ ❑ 11. OVERFILL ALARM MANLWAC7URER5 CUT SHEETS. ❑ ❑ ❑ 2. TANK PRESSURE CHECK AFTER SACKEI= ❑ ❑ ❑ 12. PIPE MANUFACTURER'S CUT SHEETS. ❑ ❑ ❑ 3. PRIMARY PIPING TEST PRIOR TO BACKFI ❑ ❑ ❑ 13. PIPE MAN UrACTURER'S WARRANTIES ❑ ❑ ❑ 4. SECONDARY CONTAINMENT PIPING CHE(, ❑ ❑ ❑ 5. SECONDARY CONTAINMENT PIPING CHET ❑ ❑ ❑ 14.OVERFILL/SPILL PROTECTION. ❑ ❑ ❑ 6. PIPING/TRAHSTION SUMP CHECKS. ❑ ❑ ❑ 15. TRANSITION SUMPS. ❑ ❑ ❑ 7. 48 HOUR NOTIFICATIONS ❑ ❑ ❑ 16. TIGHT -FILL FITTINGS AND ADAPTERS. ❑ ❑ ❑ 17. CHECK VALVES. CLONE E AAD FSAOVAI ❑ ❑ ❑ IS, EXTRACTOR HOUSINGS ❑ ❑ ❑ 19. STAINLESS STEEL n.:X CONNECTORS ..__......._._...... ❑ ❑ ❑ 2D. CONTAINMENT FITTINGS, YFS NO k/A ❑ ❑ ❑ 21. MANWAY LDS. ❑ ❑ ❑ 1. TEMPORARY CLOSURE CUPA INSPECTION, ❑ ❑ ❑ 22. DEAD MEN. ❑ ❑ ❑ 2. TEMPORARY CLOSURE DUSTO OSPECTIO[ ❑ ❑ ❑ 23. OBSERVATION S ❑ ❑ ❑ 3. VEEDER ROOT DISCONNECT NOTRICATTON ❑ ❑ ❑ 24. CDRROSON RESISTANT COATINGS. ❑ ❑ ❑ 4. APPROVAL LETTER TO BACKFILL. ❑ ❑ ❑ 25. OTHER ❑ ❑ ❑ 5. CLOSURE REPORT. ❑ ❑ ❑ S. ALL TRANSMITTALS INCLUDING SEND /R[ -___ TEF3TNp AND CER FmTxm ❑ ❑ ❑ 1. 3 VANTAGE POINTS OF CONSTRUCTION STE PRIOR TO CDNSTRUCMM YES NOWA ❑ ❑ C]2. DAILY EXCAVATION. [3❑ ❑ 1. MONITORING SYSTEM CERTIFICATION. ❑ ❑ ❑ 3. COMPLETED EXCAVATION. ❑ ❑ ❑ 2. SPILL BUCKET CERTIFICATION. ❑ ❑ ❑ 4. CONCRETE REINFORCEMENT STEEL IN PLACE FOR HDD -DOWN PAD. ❑ ❑ ❑ 3. SB -989 CEFIVICATm. ❑ ❑ ❑ 5. POURING CONCRETE HOLD-DOWN PAD. ❑ ❑ ❑ 4. PRECISION TIGHTNESS TESTS LUES ❑ ❑ ❑ 6. PLACEMENT OF PEA GRAVEL BEDDING ON SLAB. ❑ ❑ ❑ 5. EID TESTS ❑ ❑ ❑ 7. PRESSURE TESTING TANK PRIOR TO INSTALLATION. ❑ ❑ ❑ & CATHODIC PROTECTION. ❑ ❑ ❑ S. SETTING TANK ON PEA GRAVEL BEDDING. ❑ ❑ ❑ 7. TNTC INTEGRITY TESTING. ❑ ❑ ❑ 9. OBSERVATION WELL INSTALLATION. ❑ ❑ ❑ B. 48 HOUR NOTIFICATIONS ❑ ❑ ❑ 10. ANCHORING TANK AND COATING ANCHOR COMPONENTS WITH CORROSION RESISTANT MATERIAL ❑ ❑ ❑ IT. PLACEMENT OF PEA GRAVEL BACKFILL TO TOP OF TANK. AS-OLA_T DttAUWNM TO SOAL.E ❑ ❑ ❑ 12. INSTALLATION OF ALL PIPE RISERS AND CORROSION RESISTANT COATING IF APPLICABLE. s.. RED LINE ANY AND ALL CHANGES FROM THE ORIGINAL PLA ❑ ❑ ❑ 13. INSTALLATION OF PIPING SUMPS. YES NO N/A ❑ ❑ ❑ 14. PIPE TRENCHES AND PEA GRAVEL BEDDING ❑ ❑ ❑ t. TANK AND UNDERGROUND PIPING NETWO ❑ ❑ ❑ 15. PIPE INSTALLED ON PEA GRAVEL BEDDING. ❑ ❑ ❑ L ALL APPURTENANCE IDENTIFIED ON TAN ❑ ❑ ❑ 16. EACH TRANSITION SUMP INSTALLED. ❑ ❑ ❑ 1 PIPING SCHEMATIC FOR BASEMENT. ❑ ❑ ❑ 17. PIPING SUMP AND SPILL CONTAINMENT LAKE TESTS. ❑ ❑ ❑ 4. ALL COMPONENTS OF THE FUEL SYSTEM ❑ ❑ ❑ 18. BURRING WALL PENETRATIONS FOR PIPE. A SIGNIFICANT STRUCTURE ON STE. ❑ ❑ ❑ 19. BACKFILL PLACEMENT TO SUBGRADE. ❑ ❑ ❑ & ALL UNDERGROUND UTILITIES ENCOUNIFE( ❑ ❑ ❑ 20. FINE GRADED AFFECTED AREA OF CONSRiUCTION. ❑ ❑ ❑ 21. CONCRETE REINFORCEMENT STFFJ. IN PLACE FOR SURFACE SLAB. ❑ ❑ ❑ zz'CONCRETE POUR OF SURFACE SLA& ❑ ❑ ❑ 21 FINISHED PROJECT. ❑ ❑ ❑ 24. SERIES OF BASEMENT ENGINE ROOM PHOTOS TD ENCOMPASS ALL PIPING AND VEEDFR ROOT LEAK DETECTION SYSTEM.