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40 00 <br /> NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME: 7-Eleve.ti 54oi2e Zx37—3Z26Z ADDRESS: <br /> 7'Z.1 c CA <br /> XSAMe,5 T_i/ <br /> PR# TANK# �1 21 3 UL# TANK MODEUMATERIAL: f'e bcrt l qsS <br /> COMPARTMENTALIZED TANK?(If yes, complete one form for each tank) YES NO <br /> TANK CAPACITY: fo,®o® /0,000 PRODUCT: <br /> GaS®!r w e <br /> DATE A INITIALS <br /> P <br /> P <br /> 0 ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE WITH MANUFACTURER WRITTEN <br /> e SPECIFICATIONS <br /> D <br /> J- UST PLANS SUBMITTED AND FEES PAID (H&S QQDE SEQTIQN 2-13287) <br /> INITIAL IN PE TION <br /> 3. INSPECTION AND TEST OF SECONDARY CONTAINMENT:HOLIDAY TEST: VACUUM: SOAP: <br /> PSI. HRSIMIN- BRINE(LIQ AbIblIll AIR)- QIHEB, <br /> 4. PRIMABYjAblK JEST- <br /> PIPING INSPECTIONS <br /> ri. PRIMARY PIPING TESI(MINIMUM 40 PS1130 MIN) CIR 2R3134e)l <br /> 8. LAKE TEST QN ALL SUMPS(24 HE MINIMUM) HRS- rQQR 96350)(Q1 <br /> Q. UNUSED TANK OPENINGS SEALED AND COWROSIM P[ROTFQTFD PEI <br /> 10 nVP:RSPILL PERFORMANCE TEST ICCE 2615(b)(1)(" <br /> 12 PIPING SLOPES TQ cml-ErmoN sume (CCR 2636(c)(1)] <br /> FINAL INSPECTION <br /> 13, PERFQBMANrEIESTFQR"ALL"MQNIIQRINGPBQBES rr-r-R 2932(c)(2)] <br /> 16. PERFQfRMANCE TEST OF AUTOMATIC PUMP SYSTEMSBUT QEF <br /> 17 -13ALLBLAIIIAUVES INSTALLED <br /> 18. OVERFILL PROTECTION IN,9TALLFD AND APPIROVED (CCR 2635(b)(2)] <br /> 19- IANK ACCESS E!QRM BROUGHT IQ GRADE(LOCKED AND YVATERTIGHI) - API <br /> -20. TANK INTEGRITY TESI PERFORMED(HARD GQPY SUBMITTED) [QCR 2635(a)(5)1 <br /> 21. MONITORING PLAN-RESPONSE ELAN,AND I Or.ROOK ON SITE ECCER 913132(d)l <br /> 29 "C" ORM COMPLETED AND SUBMITTED [CCR-2635(d)j <br /> 123 MONITORING MEIHQQ FOR ALL TANKS AND PIPING APPBQVED <br /> 1 24. ALL CONDITIONS MET-FACILITY PERMIT ISSUED (HM CODF 959A <br /> COMMENTS <br /> EH23 006 3/15/02 <br /> 10 <br />