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it Itw =V• t=�-V A•" YES NO N/A N/A E] ❑ 0 1. APPROVED CUPA PERMIT W/ SIGN OFF. 0 0 ❑ 2. APPROVED FIRE DEPARTMENT PERMIT W/ SIGN OFF. ❑ 0 ❑ 3. APPROVED BUILDING PERMIT WITH SIGN OFF. ❑ 0 ❑ 4. ADDITIONAL PERMITS REQUIRED W/ SIGN OFF. Cj 0 0 5. AQMD (ATC). E] F] F1 6. U.S.A. EXCAVATION PERMIT NO. E] E ❑ 7. AT&T MOP. 0 n ❑ 8. SITE SPECIFIC HEALTH & SAFETY PLAN. 0 ❑ 9. PROJECT SCHEDULE. F n 10. 48 HOUR INSPECTION NOTIFICATIONS. E] E] [3 11. LETTER OF COMPLETION (REPAIRS ONLY). I] ❑ 12. FORM "C". ® n 13. PERMIT EXTENSIONS. 14. ALL AGENCY CORRESPONDENCE/ W CONFIRMATIONS. 1, TANK MANUFACTURER'S CUT SHEETS/TANK CHART. 2. TANK MANUFACTURER'S WARRANTY. 3. COMPLETED MANUFACTURER'S INSTALLATION CHECKLIST. 4. PIPING SUMPS MANUFACTURER'S CUT SHEETS/WARRANTY. 5. DAY TANK MANUFACTURER'S CUT SHEETS/ TANK CHART. S. DAY TANK MANUFACTURER'S WARRANTY. 7. PUMPS MANUFACTURER'S CUT SHEETS B. MONITORING SYSTEM MANUFACTURER'S CUT SHEETS. 9. MONITORING SYSTEM MANUFACTURER'S WARRANTIES. 10. HYDROSTATIC MONITORINFG FLUID - CUT SHEETS. 11. OVERFILL ALARM MANUFACTURER'S CUT SHEETS. 12. PIPE MANUFACTURER'S CUT SHEETS. 13. PIPE MANUFACTURER'S WARRANTIES. 14. OVERFILL/SPILL PROTECTION. 15. TRANSITION SUMPS. 16. TIGHT -FILL FITTINGS AND ADAPTERS 17. CHECK VALVES. 18. EXTRACTOR HOUSINGS. 19. STAINLESS STEEL FLEX CONNECTORS. 20. CONTAINMENT FITTINGS. 21. MANWAY LIDS. 22. DEAD MEN. 23. OBSERVATION WELLS 24. CORROSION RESISTANT COATINGS 25. OTHER YES NO N/A N/A 1. POTS LINE ORDER & SERVICE FORM. ❑ ❑ 1. 3 VANTAGE POINTS OF CONSTRUCTION SITE PRIOR TO CONSTRUCTION. n Ej n 2. DAILY EXCAVATION. 5. 48 HOUR INSPECTION NOTIFICATION REQUEST. (CURRENT - 24 MONTHS). n 3. COMPLETED EXCAVATION. ® [:] ❑ 4. CONCRETE REINFORCEMENT STEEL IN PLACE FOR HOLD-DOWN PAD. Cj n n 5. POURING CONCRETE HOLD-DOWN PAD. E] n [:] S. PLACEMENT OF PEA GRAVEL BEDDING ON SLAB. MFG'S RECOMMENDATION OR 36 MONTHS WHICHEVER IS SHORTER). E ❑ 7. PRESSURE TESTING TANK PRIOR TO INSTALLATION. ® ❑ 8. SETTING TANK ON PEA GRAVEL BEDDING. 0 ❑ 9. OBSERVATION WELL INSTALLATION. E] n 10. ANCHORING TANK AND COATING ANCHOR COMPONENTS WITH CORROSION RESISTANT MATERIAL. I] ❑ 11. PLACEMENT OF PEA GRAVEL BACKFILL TO TOP OF TANK. ® n 12. INSTALLATION OF ALL PIPE RISERS AND CORROSION RESISTANT COATING IF APPLICABLE. n n 13. INSTALLATION OF PIPING SUMPS. 14. PIPE TRENCHES AND PEA GRAVEL BEDDING. E n 15. PIPE INSTALLED ON PEA GRAVEL BEDDING. E ❑ 16. EACH TRANSITION SUMP INSTALLED. n 17. PIPING SUMP AND SPILL CONTAINMENT LAKE TESTS. ® [:] 18. BUILDING WALL PENETRATIONS FOR PIPE. Ej 19. BACKFILL PLACEMENT TO SUBGRADE. ❑ 20. FINE GRADED AFFECTED AREA OF CONSTRUCTION. E] n 21. CONCRETE REINFORCEMENT STEEL IN PLACE FOR SURFACE SLAB. ❑ E] E] 22. CONCRETE POUR OF SURFACE SLAB. ® n n 23. FINISHED PROJECT. E] [3 f -I 24. SERIES OF BASEMENT ENGINE ROOM PHOTOS TO ENCOMPASS ALL PIPING AND VEEDER ROOT LEAK DETECTION SYSTEM. Brum, Gra .• �I CONTRACTOR OU�s Ae TIOW YNO ES N/A 1. POTS LINE ORDER & SERVICE FORM. ❑ ❑ 1. CALIFORNIA STATE CONTRACTORS LICENSE. ❑ Ej 2. CURRENT ICC UST INSTALLATION/RETROFITTING CERTIFICATION ® 5. 48 HOUR INSPECTION NOTIFICATION REQUEST. (CURRENT - 24 MONTHS). 6. SYSTEM DISCONNECT (EH&S NOTIFICATION). 3. CURRENT ICC TANK REMOVAL CERTIFICATION (CURRENT - 24 MONTHS). ❑ ❑ ❑ E] 4. CURRENT TANK MANUFACTURER'S INSTALLER CERTIFICATION (USE 9. OTHER MFG'S RECOMMENDATION OR 36 MONTHS WHICHEVER IS SHORTER). Ej E] E] 5. CURRENT PIPE MANUFACTURER'S INSTALLATION CERTIFICATION (USE MFG'S RECOMMENDATION OR 36 MONTHS WHICHEVER IS SHORTER). E E] 6. VEDDER ROOT MONITORING SYSTEM TECHNICIAN'S CERTIFICATION (MUST BE MFG'S HIGHEST RANKING LEVEL OR CERTIFICATION). 7. CONTRACTOR'S WORKMANSHIP WARRANTY. YES NO N/A ❑ 1. POTS LINE ORDER & SERVICE FORM. Ej ❑ E] 2. ALARMS TESTED AND CONFIGURED TO PROPER SETTINGS. 0 ® 3. WARRANTY START-UP FORM. Ej 4. QA/OC VEEDER ROOT CONSOLE. ® 5. 48 HOUR INSPECTION NOTIFICATION REQUEST. Cj E] Ej 6. SYSTEM DISCONNECT (EH&S NOTIFICATION). 7. WARRANTY, OWNER'S, AND OPERATOR'S MANUALS. ❑ ❑ ❑ 8. MONITORING FLUID CERTIFICATION. E] [:] E] 9. OTHER OUT ATM ON COMPLETION OF THE PROJECT PROVIDE 3 COPIES IN 3 -RING BINDERS AND 1 CD OF ALL INFORMATION LISTED TO THE CA PST PROJECT MANAGER FOR DISTRIBUTION 3 OPERATION AND MAINTENANCE BINDERS (SEPARATE FROM ABOVE) •°° PRINT AND SIGN YOUR NAME TO INDICATE FINAL ACCEPTANCE OF WORK AFTER FINAL INSPECTION +°i 1. ALLIANCE ARCHITECT (AA) (FROM GC UPON PROJECT COMPLETION). AFTER AA COMPLETES REVIEW THEN DISTRIBUTE TO THE FOLLOWING; 2. EH&S - TEXAS 3. CA PST PM 4. D&C DATA ADMINISTRATOR (DA) YES NO N/A AT&T PROPRIETARY (INTERNAL USE ONLY) M M 1. TANK DELIVERY CHECKLIST. NOT FOR USE OR DISCLOSURE OUTSIDE THE AT&T COMPANIES 0 ❑ 2. TANK PRESSURE CHECK AFTER BACKFILL. EXCEPT UNDER WRITTEN AGREEMENT 3. PRIMARY PIPING TEST PRIOR TO BACKFILLING. F] E ❑ 4. SECONDARY CONTAINMENT PIPING CHECK PRIOR TO BACKFILLING. 5. SECONDARY CONTAINMENT PIPING CHECK AFTER BACKFILUNG. ® [_] 6. PIPING/TRANSITION SUMP CHECKS. E f -I 7. 48 HOUR NOTIFICATIONS, YES NO N/A E 0 1. TEMPORARY CLOSURE CUPA INSPECTION. E 0 2. TEMPORARY CLOSURE DUSTO INSPECTIONS (EVERY 2 MONTHS) 0 ® 3. VEEDER ROOT DISCONNECT NOTIFICATION. Ej 4. APPROVAL LETTER TO BACKFILL ® 5. CLOSURE REPORT. ® ❑ 6. ALL TRANSMITTALS INCLUDING SEND /RECEIVED NOTIFICATIONS 1:n I I XMI LIDXOE-_--u-._ :111 YES NO N/A E] ❑ [:] 1. MONITORING SYSTEM CERTIFICATION. ❑ ❑ 2. SPILL BUCKET CERTIFICATION. 3. SS -989 CERTIFICATION. 4. PRECISION TIGHTNESS TESTS LINES. E] n Fj 5. ELD TESTS. 6. CATHODIC PROTECTION. 7. TANK INTEGRITY TESTING. E] 8. 48 HOUR NOTIFICATIONS T DRAWNW TO SCALE «+ RED LINE ANY AND ALL CHANGES FROM THE ORIGINAL PLANS AND SPECIFICATIONS btY YES NO N/A rl 1. TANK AND UNDERGROUND PIPING NETWORK CLEARLY DEPICTED. E] E] 2. ALL APPURTENANCES IDENTIFIED ON TANK. F] n 3. PIPING SCHEMATIC FOR BASEMENT. E f-1 4. ALL COMPONENTS OF THE FUEL SYSTEM ARE SHOWN IN RELATION TO A SIGNIFICANT STRUCTURE ON SITE. E f -I 5. ALL UNDERGROUND UTILITIES ENCOUNTER CLEARLY MARKED. ►:" oum ENGINEERS, INC. 30 south lith sb, Seo ]-. G AN "", 438 14th Street, softs 200 Oeklmd. CA 5/812-2425 - 495 Foam 34 Mootaree. CA 93840-1410 (408) 282-1No six (4aJ 204-2393 aeo.eolaeahafon.eom REVISIONS AUTHORIZATIONS NO. ISSUE DATE BY ISSUE FOR am um (BOAS 10/1/10 CW RESPONSE TO CUDIT RMV (BONN) 11/1/10 CSI FM DEPART" SUBATIAL 3/15/11 CSI COPA SUBMITTAL 4/07/11 CSI PROPRIETARY AT&T INFORMATION NOT FOR ffMRAL USE OR DiSCUXURE OUISM OF AT&T. TIAs WOMWO WY ONLY BE USED 9Y 911FI0Rl&D PUMAID. OF THE LOCAL OMMM AGCY H COO&IM MIM APPLICATION FOR PD WIS AND AUMMZAIM FOR &ALDNO% CONSIRLICIM AND/ OR ZMIC OIAIM DIIAWM PWAM MR atext CORPORATE VREAL ESTATE ABOVEGROUND FUEL PIPING MODIFICATIONS FOR STANDBY GENERATOR SYSTEM 345 N. SAN JOAQUIN STREET STOCKTON,CA SKTNCAOT PROJECT CLOSMUT SHEET YIC. Td 707.765.16601 SS 1137 tL MlOwM WAIFm.7O7.765.9908 Id-_ -, G _.SA 94954 - ROD SATRE UE042 COFSIATAIT PROJECT / 9 DATE 09/30/10 SCALE: AS SINN DRWN 9Y: DS I CHECKED BY: CSB SHEET: 4 Of: 4 SHELLS SIM NO. AT&T DRWW W.: F4