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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ADDRESS: <br />FACILITY 1D# TANK# UL# TANK MODEL/MATERIAL: <br />i <br />CAPACITY: PRODUCT:C* R.E.H.S: <br />A I <br />P N ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />R T <br />0 I <br />V A <br />E L <br />D S <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPRO <br />INITIAL INSPECTIONS <br />p 3. INSPE AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />6. <br />4. PRIMARY TANK TEST: PSI: HRS/MIN: <br />(CCR <br />2636 <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />6. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) <br />(CCR <br />2636 <br />(e)) <br />14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />7. <br />SECONDARY PIPING CONTAINMENT TEST PSI: t� HRS/MIN: j OTHER: <br />(CCR <br />2636 <br />(e)) <br />i <br />Y <br />8. <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />r <br />18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br />10. <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />-1,�,t <br />✓ <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />COMMENTS:— <br />EH23-006 9/95 <br />9 10 <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 />EH23-006 9/95 <br />9 10 <br />