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NEIi UST INSTALLATION INSPECTION RECORD <br /> Y <br /> FACILITY NAME: ADDRESS: <br /> FACILITY ID# TANKS ULt TANK *MEL/MATERIAL: <br /> CAPACITY: PRODUCT: <br /> A I <br /> P N ®) ALL TANKS TO BE INSTALLED AMC TESTED IN ACCORDANCE <br /> P I WITH MANUFACTURER WRITTEN SPECIFIC&TIONS <br /> R T <br /> 0 I B <br /> V A [ <br /> L <br /> 0 S <br /> ITEM OR EQUIPMENT INSPECTED <br /> OATS <br /> 1 1 1. UST PLANS SUBMITTED/ FES PAID (H+S CODE 252873 <br /> 1 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPEC:TONS <br /> gyp " Ile 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT: HOLIDAY: <br /> 6 VACLUFI: ?SI: iiRS/MIN: 3RINELLICi12D ANNULAR): OTHER: <br /> 14, PRIMARY TANK TEST: PSI: _1,0HRS/MSN: <br /> �^ 1 5. TANK APPROPRIATELY PLACED W%TM APPROVED 3ACKFILL (API/PEI) <br /> PIPING INSPEC:lCHS <br /> 6. PRIMARY PIPING TEST (ximinum 4a PSI/3a mix) (CGI 2636 (e)) <br /> 1 1 7. SEMNDARY PIPING COUTAIM40T TEST PSI: HRS/MIN: OTHER: (aaZ636 (e)) <br /> 1 18. LAKE ,EST ON ALL SUMS (24 HR. MINIMUM) HRS: 2635 (a) (4)) <br /> 9. WRZED TANK OPERINGS SEALED AND =ROSICH PqOTECM PEI <br /> 110. OVERSPILL PStFORMANCS TEST <C:i 2635 (b) (1) (C)) <br /> (11. ALL PIPING AND FITTINGS CORROSION PROTEzC--M. D (C'.+t' 2636 (b)) <br /> I12. PIPING SLOPES TO COLLECTION AARP CC= 2636 (c)(1)) <br /> FINAL !XSPEC'ION <br /> v� Sf 113. PeFORMANCE TEST FOR "ALL- NOMITORING PROBES (CGI 2632 (c) (2)) <br /> 1 1fl 14. PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CGI 2632 (c) (2)) <br /> J 115. PERFORMANCE TEST OF LINE LEAK OETECTIOMM 2643 Cc) (1)) <br /> 1 >)116. PERFORMANCE TESL' OF AUTCeMATIC PUMP SYSTEM SHUT`-OFF CCG( 2636 (S)) <br /> 17. SALL FLOAT VALVES INSTALLED <br /> S118. OVERFILL PROTECTION INSTALLED/APPROVED (CCR 263"5 (b) (2)) <br /> 119. TANK ACCESS PMTS BROUGHT TO (MADE (LOCXO AND WATERTIGHT) API <br /> 120' TANK INTEGRITY TEST (PASSING HARD COPT) (CCR Z635 (a) (5)) <br /> f i 1 21. MONITORING PLAN, RESPONSE PIAN AND LOG 300K ON SITE CCIai 2632 (d)) <br /> i 122- -c- FORM COMPLETED AND AIBMITTEO (cCa 2635 (d)) <br /> (✓f 123. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> fJ124. ALL CONDITIONS NET; FACILITY PERMIT ISSUED (H+S CODE 25284) <br /> COMMENTS: <br /> SH23-706 9/95 7 <br />