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NEW UST INSTALLATION INSPECTION RECORD <br />FACILITY NAME: ADDRESS: <br />FACILITY ID# TANKS' UL.i' TAN MMELMATE:tIAL: <br />CAPACITY: PRODUCT: <br />INITIAL INSPEC74109S <br />3. INSPECTION AND TEST OF SECONDARYCONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: ARS/MIN: 3RINE(LICUID ANNULAR): OT)IER: <br />4. PRIMARY TANK TEST: PSI: HRSMIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFILL (APT/PEI) <br />PIPING INSPECTIONS <br />I16. <br />A <br />I <br />I17. <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CGI Z636 (e)) <br />P <br />N <br />ALL TANKS TO SE INSTALLED AND TESTED IN ACCvROANCEE <br />P <br />I <br />WITH AAMUFACTURSE WRITTEN SPECIFICATIONS <br />R <br />T <br />I11. ALL PIPING A90 FITTINGS CORROSION PROTEC7E (CCX 2636 (b)) <br />O <br />I <br />17. BALL FLOAT VALVES INSTALLED <br />V <br />A <br />(18. OVERFILL PROTECTION INSTALLED/APPR (CCR 2635 (b) (2)) <br />E <br />L <br />TANK ACCESS PORTS 3RDUGHT TO GRACE (LOCKED AND WATERTIGHT) API <br />0 <br />S <br />IZO. TANK INTEGRITT TEST (PASSING Y) (C:ai 2635 (a) (5)) <br />II21. <br />ITLM OR SUIPME14T INSPECTED <br />OATS <br />II <br />I22. <br />"C" FORM COMPLETED AND SUBMITTED (CGT 2635 (d)) <br />I( <br />I23. MBNITCRING METHOD FOR ALL TANKS AND PIPING APPROVED (CGI 2630-206) <br />I24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S (DDE 25284) <br />1. UST PUNS SUBMITTED/ PES PAID (H+S CODE 25287) <br />I12. <br />UST INSTALLATION PLANS APPROVED <br />INITIAL INSPEC74109S <br />3. INSPECTION AND TEST OF SECONDARYCONTAINMENT: HOLIDAY: <br />VACUUM: SOAP: PSI: ARS/MIN: 3RINE(LICUID ANNULAR): OT)IER: <br />4. PRIMARY TANK TEST: PSI: HRSMIN: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED 3ACXFILL (APT/PEI) <br />PIPING INSPECTIONS <br />I16. <br />PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br />I17. <br />SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CGI Z636 (e)) <br />8. LAKE TEST ON ALL SUMPS (24 HR. MINI") ARS: (CGT 2635 (a) (4)) <br />9. UNUSED TANK OPENINGS SEALED AND =RCSICN PROTECTED PEI <br />I15. PERFORMANCE TEST OF LINE LEAK DETECTION (Cuff 2643 (c) (1)) <br />I10. OVERSPILL PERFORMANCE EST (= 26.335 (b) (1) (C)) <br />I11. ALL PIPING A90 FITTINGS CORROSION PROTEC7E (CCX 2636 (b)) <br />I12. PIPING SLOPES TD COLLECTION SW (CCR 2636 (c)(1)) <br />FINAL INSPECTION <br />COMMENTS: <br />::423-006 9/95 T <br />I13. PERFORMANCE TEST FOR "ALL" MONITORING PROSES CCGi 2632 (c) (2)) <br />(14. PERFORMANCE TEST OF CONTI ITONING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br />I15. PERFORMANCE TEST OF LINE LEAK DETECTION (Cuff 2643 (c) (1)) <br />I16. PERFORMANCE TEST OF AUT04ATIC PUMP STST-r-MSHUT-OFF (CCT 2636 (g)) <br />17. BALL FLOAT VALVES INSTALLED <br />(18. OVERFILL PROTECTION INSTALLED/APPR (CCR 2635 (b) (2)) <br />II19. <br />TANK ACCESS PORTS 3RDUGHT TO GRACE (LOCKED AND WATERTIGHT) API <br />IZO. TANK INTEGRITT TEST (PASSING Y) (C:ai 2635 (a) (5)) <br />II21. <br />MONITORING PWT, RESPONSE PLAN AND LOG 300K ON SITE CCC2 2632 (d)) <br />II <br />I22. <br />"C" FORM COMPLETED AND SUBMITTED (CGT 2635 (d)) <br />I( <br />I23. MBNITCRING METHOD FOR ALL TANKS AND PIPING APPROVED (CGI 2630-206) <br />I24. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S (DDE 25284) <br />COMMENTS: <br />::423-006 9/95 T <br />