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(Nr—VV UJ I INN I HLLN I IUN IN51'CCr I lUN HtUUHO <br /> ITT MAKE: �� ADDRESS: <br /> CEPS# TANK! � Ulf ( TANK MCOEL/MATERIAL: pG G pp4a� <br /> r <br /> CAPACITY: , IG PRODUCT: AR�' R.E.H.S: G–" "— <br /> A I <br /> P MALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T <br /> O I <br /> V A <br /> E L <br /> D S <br /> DATE <br /> ITEM OR EQUIPMENT INSPECTED <br /> /lj q 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287, CCR 2635 (D) (8) <br /> 2. UST INSTALLATION PLANS APPROVED (CCR 2635 (E) (5)) <br /> INITIAL INSPECTIONS <br /> INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> VACUUM: SOAP: PSI: HRS/MIN: BRINE(LIQUID ANNULAR): OTHER: <br /> l2 ( 4. PRIMARY TANK TEST: PSI: .�E.'"/,,,5r HRS/MIN- <br /> 6 a �rK <br /> ®r 5. TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (CCR 2635 (A) (3) (4) (6)/ API/PEI) <br /> PIPING INSPECTIONS <br /> 6. PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIM) (CCR 2635 (B) (4)) <br /> / 7. SECONDARY PIPING CONTAdMQSENT TEST PSI: NRS IN: OTHER: (CCR 2635 (A) (4)) <br /> LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) ZHR : (CCR 2635 (A)) <br /> 9. UNUSED TANK OPENINGS SEALED AND CORROSION PROTECTED (CCR 2635) <br /> Il lg F ✓ �r 10. OVERSPILL PERFORMANCE TEST (CCR 2635 (A) (4)) <br /> ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2635 (B)) <br /> FINAL INSPECTION <br /> MIjB ' 12. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (C) (2)) <br /> 13. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM, (PANEL) (CCR 2632 (A) (2)) <br /> 1fl�j / ✓ `t 14. PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2632 (D) 2635 (B) (5)) <br /> 6.115. PERFORMANCE TEST OF AUTOMATIC PUMP SYSTEM SHUT-OFF (CCR 2635 (B) (5)) <br /> I (� ✓ ff" 16. BALL FLOAT VALVES INSTALLED (CCR 2635 (8) (6)) <br /> I�/g 7. OVERFILL PROTECTION INSTALLED/APPROVED (CCA 2635•(E) (2)) <br /> / ®f 07 ✓ f 18. TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) (CCR 2631 (D) (5)) <br /> / ✓ 19. TANK INTEGRITY TEST (PASSING HARD COPT) <br /> (CCR 2635 (A) (5)) <br /> ,/ 20- MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE <br /> (CCR 2632 (E) (i) (2)) <br /> 7 I ✓ Kf 21. •C` FORM COMPLETED AND SUBMITTED (CCR 2635 (E)) <br /> MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2641-2644) <br /> 23. ALL CONDITIONS MET; FACILITY PERMIT ISSUED (H+S CODE 25284 (E) (F)) <br /> COMiMENTS:-A/111,6_ R r r,,,OP3 gS ®; <br /> EH23-006 3/92 (REVISED 11\92) <br />