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NEW UST INSTALLATION INSPECTION RECORD <br /> fACIIITY NAME: t ADDRESS: ldw <br /> FACILITY ID# TANK# UL# TANK k=EWMATERIALi Q <br /> CAPACITY: PRODUCT: Lz0$ 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. USS INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: MRS/MIN: 0 BRINE(LIQUID ANNULAR): OTHER: <br /> 4. PRIMARY TANK TEST: PSI: mfr HRS/MIN: <br /> 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILLf 7 API/PEI) <br /> PIPING INSPECTIONS <br /> PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br /> 7. SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN:�°� ) OTHER: (CCR 2636 (e)) <br /> rf �- L/ U r 8. LAKE TEST ON ALL SUMPS (24 HR. MINIMUM)-• :HRS: (CCR 2635 (a) (4)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED PEI <br /> 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> J/ 12. PIPING SLOPES TO COLLECTION SUMP (CCR 2636 (c)(1)) <br /> FINAL INSPECTION <br /> S 13. PERFORMANCE TEST FOR "ALV' MONITORING PROBES (CCR 2632 (c) (2)) <br /> ! f 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/APPROVEDOW (CCR 2635 (b) (2)) <br /> Z' 19. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) API <br /> J 120. TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> �- -3 21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> 122. "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 /> I <br /> COMMENTS:- 04 I&AJ aa2x T'l ) <br /> EH23-006 9/95 <br /> 10 <br />