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• <br />• <br />NEW UST INSTALLATION INSPECTION RECORD <br />1 <br />FACILITY NAME: &�Mgc-- Meigi5r ADDRESS: s <br />PRIMARY PIPING TEST MINIMUM 40 PSI/30 MIN 's <br />PR # TANK# UL# TANK MODEUMATERIAL: <br />COMPARTMENTALIZED TANK? (If yes, complete one form for each tank) <br />❑ YESNO <br />TANK CAPACITY: �'2�� 4 o/✓ PRODUCT: <br />�� <br />DATE A INITIALS <br />P <br />R ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br />SPECIFICATIONS <br />E <br />D <br />INITIAI INCP1=rTIf1NG <br />i DIDIKIr. 1NCP1=rTI[1NS I , 9 1'�W'V7 <br />6. <br />PRIMARY PIPING TEST MINIMUM 40 PSI/30 MIN 's <br />3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY TEST: VACUUM: <br />SOAP: PSI: HRS/MIN: BRINE LIQUID ANNULAR): OTHER: <br />7. <br />SECONDARY PIPING CONTAINMENT TEST: PSI: HRS/MIN <br />4. PRIMARY TANK TEST: <br />8. <br />LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: <br />5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL API/PEI <br />i DIDIKIr. 1NCP1=rTI[1NS I , 9 1'�W'V7 <br />6. <br />PRIMARY PIPING TEST MINIMUM 40 PSI/30 MIN 's <br />S SZ CCR 2636 e <br />7. <br />SECONDARY PIPING CONTAINMENT TEST: PSI: HRS/MIN <br />OTHER: rCCR 2636(e)] <br />8. <br />LAKE TEST ON ALL SUMPS 24 HR MINIMUM HRS: <br />rCCR 2635 a 4 <br />9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED <br />10. OVERSPILL PERFORMANCE TEST <br />PEI <br />CCR 2635 b 1 C <br />101 0 V. 11. <br />ALL PIPING AND FITTINGS CORROSION PROTECTED <br />fCCR 2636(b)] <br />4011 0 12. <br />PIPING SLOPES TO COLLECTION SUMP <br />FCCR 2636 c 1 <br />-ji\L nE"KLl73ai d ril \ 1 <br />13. <br />PERFORMANCE TEST FOR "ALL" MONITORING PROBES <br />CCR 2632(c 2 <br />14. <br />PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM <br />CCR 2632 c 2 <br />VJ 41- 15. <br />PERFORMANCE TEST OF LINE LEAK DETECTION <br />CCR 2643 c 1 <br />16. <br />PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT OFF <br />fCCR 2636 <br />17. <br />BALL FLOAT VALVES INSTALLED <br />18. <br />OVERFILL PROTECTION INSTALLED AND APPROVED <br />fCCR 2635 b 2 <br />19. <br />TANK ACCESS PORTS BROUGHT TO GRADE LOCKED AND WATERTIGHT <br />API <br />20. <br />TANK INTEGRITY TEST PERFORMED HARD COPY SUBMITTED <br />CCR 2635 a 5 <br />21. <br />MONITORING PLAN RESPONSE PLAN AND LOG BOOK ON SITE <br />fCCR 2632 d <br />22. "C" FORM COMPLETED AND SUBMITTED <br />FCCR 2635' d <br />0 J 23. <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 25284 <br />EH23 006 3/18/02 <br />10 <br />