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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: Q ' � VV(Ar ADDRESS: <br />FACILITY ID# TANK# UL# TANK MODEL/MATERIAL: <br />CAPACITY: PRODUCT::LLj!jet— R.E.H.S: <br />3. INSPECTION AND T,F_ST'OF SECONDARY CONTAINMENT: HOLIDAY: <br />I <br />VACUUM:_"` SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />A <br />I <br />14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />4. -"'""N PRIMARY TANK TEST: PSI: HRS/MIN: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />p <br />I <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />R <br />T <br />17. BALL FLOAT VALVES INSTALLED <br />0 <br />I <br />18. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br />V <br />A <br />19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br />E <br />L <br />20. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br />D <br />S <br />21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br />ITEM OR EQUIPMENT INSPECTED � <br />DATE <br />23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />2. UST INSTALLATION PLANS APPROVED <br />INLT-IAL INSPECTIONS <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />3. INSPECTION AND T,F_ST'OF SECONDARY CONTAINMENT: HOLIDAY: <br />I <br />VACUUM:_"` SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br />14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />4. -"'""N PRIMARY TANK TEST: PSI: HRS/MIN: <br />15. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 (c) (1)) <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br />PIPING INSPECTIONS <br />FINAL INSPECTION <br />COMMENTS:— <br />EH23-006 9/95 <br />0 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 />0 10 <br />