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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: i le -"> O P .1 ADDRESS: ;;L -s5 F 5 <br />FACILITY ID# TANK# UL#• ifQ TANK-EL/MATERIAL: <br />CAPACITY: 10 1 ®C?® PRODUCT: R.E.H.S: <br />INITIAL INSPECTIONS <br />II3 '�9 <br />A <br />I <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) s <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />P <br />N <br />ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br />VACUUM: SOAP: PSI: HRS/MIN: <br />P <br />R <br />I <br />T <br />WITH MANUFACTURER WRITTEN SPECIFICATIONS <br />(�, <br />'To <br />PRIMARY TANK TEST: /� _5PSI: <br />0 <br />I <br />`� <br />TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />V <br />E <br />A <br />L <br />2635 <br />(a) (4)) <br />0 <br />S <br />/ <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />ITEM OR EQUIPMENT INSPECTED <br />DATE <br />CCCR 2635 (b) (2)) <br />. <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />2. UST INSTALLATION PLANS APPROVED <br />INITIAL INSPECTIONS <br />II3 '�9 <br />7fo 9.PERFORMANCE <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) s <br />INSPECTION AND TEST OF SECONDARY CONTAINMENT: <br />HOLIDAY: <br />(e)) <br />42-3 ® <br />VACUUM: SOAP: PSI: HRS/MIN: <br />BRINE(LIQUIO ANNULAR): OTHER: <br />U3__� <br />4. <br />PRIMARY TANK TEST: /� _5PSI: <br />HRS/MIN:5. <br />(CCR 2643 (c) (1)) <br />TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL <br />(API/PEI) <br />PIPING INSPECTIONS <br />r6. <br />7fo 9.PERFORMANCE <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) s <br />. (CCR <br />2636 <br />(e)) <br />42-3 ® <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (c) (2)) <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MI OTHER: <br />(CCR <br />2636 <br />(e)) <br />(CCR 2643 (c) (1)) <br />LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: <br />(CCR <br />2635 <br />(a) (4)) <br />9. <br />UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />PEI <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />CCCR 2635 (b) (2)) <br />. <br />OVERSPILL PERFORMANCE TEST <br />(CCR <br />2635 <br />(b) (1) (C)) <br />11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />(CCR <br />2636 <br />(b)) <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />12. <br />PIPING SLOPES TO COLLECTION SUMP <br />(CCR <br />2636 <br />(c)(1)) <br />FINAL INSPECTION <br />COMMENTS: <br />EH23-006 7/97 <br />10 <br />7fo 9.PERFORMANCE <br />TEST FOR "ALL" MONITORING PROBES <br />(CCR 2632 (c) (2)) <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) <br />(CCR 2632 (c) (2)) <br />15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION t' <br />(CCR 2643 (c) (1)) <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF <br />(CCR 2636 (g)) <br />BALL FLOAT VALVES INSTALLED kit) � v <br />OVERFILL PROTECTION INSTALLED/APPROVED <br />CCCR 2635 (b) (2)) <br />cp <br />J20. <br />TANK ACCESS PORTS BROUGHT �RADEOC <br />LKED AND WATERTIGHT) <br />API <br />TANK INTEGRITY TEST (PASSING HARD COPY) FA xett <br />(CCR 2635 (a) (5)) <br />MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br />(CCR 2632 (d)) <br />"C" FORM COMPLETED AND SUBMITTED <br />(CCR 2635 (d)) <br />g' <br />'40l,��• <br />- <br />MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED <br />(CCR 2630-2636) <br />24. <br />ALL CONDITIONS MET; FACILITY PERMIT ISSUED <br />(H+S CODE 25264) <br />COMMENTS: <br />EH23-006 7/97 <br />10 <br />