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---NEW UST INSTALLATION INSPECTION RECORD <br /> FACILITY NAME:�N , �, . , •E ADDRESS- r - -2 E •'�� <br /> FACILITY ID# f 1 I TANK# UL# TANK 40DEL/MATERIAL: <br /> CAPACITY: . �r�0 1G1 PRODUCT: R.E.H.S: <br /> A I <br /> P N ALL TANKS TO BE INSTALLED AND TESTED IN ACCORDANCE <br /> P 1 WITH MANUFACTURER WRITTEN SPECIFICATIONS <br /> R T - <br /> E L <br /> 0 <br /> STEM OR EQUIPMENT I SAN ECTED r �Grj �I71� �L +-'�Q <br /> DATE <br /> 1. UST PLANS SUBMITTED/ FEES PAID (H+S CODE 25287) <br /> 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTIONS <br /> 11 INSPECTION AND TEST OF SECONDARY CONTAINMENT;jii;alk HOLt AY: <br /> l i <br /> VACUUM: SOAP: PSI: HRS/M1H: BRINE(LIDUID ANNULAR): V OTHER- <br /> PR I MARY TANK TEST: f) r^e S S"At,,4- PSI: �! 5 HRS/MIN: l <br /> TANK APPROPRIATELY PLACED WITH APPROVED BACKFILL (API/PEI) <br /> PIPING INSPECTIONS <br /> PRIMARY PIPING TEST (MINIMUM 40 PSI/30 MIN) (CCR 2636 (e)) <br /> a- c SECONDARY PIPING CONTAINMENT TEST PSI: HRS/MIN: OTHER: (CCR 2636 (e)) <br /> LAKE TEST ON ALL SUMPS (24 HR. MINIMUM) HRS: (CCR 2635 (a) (4)) <br /> UNUSED TANK ❑PENINGS SEALED AND CORROSION PROTECTED PEI <br /> 0. OVERSPILL PERFORMANCE TEST (CCR 2635 (b) (1) (C)) <br /> 11. ALL PIPING AND FITTINGS CORROSION PROTECTED (CCR 2636 (b)) <br /> 12, PIPING SLOPES TO COLLECTION SUMP {CCR 2636 (c)(1)) <br /> FINAL INSPECTIOM <br /> �-f- 7. PERFORMANCE TEST FOR "ALL" MONITORING PROBES (CCR 2632 (c) (2)) <br /> PERFORMANCE TEST OF CONTINUOUS MONITORING SYSTEM (PANEL) (CCR 2632 (c) (2)) <br /> 117, <br /> . PERFORMANCE TEST OF LINE LEAK DETECTION (CCR 2643 Cc) (1)) <br /> PERFORMANCE TEST OF AUTOMATIC PUMP 5YS�TE NUT- F (CCR 2636 (g)) <br /> BALL FLOAT VALVES INSTALLED '- � <br /> OVERFILL PROTECTION INSTALLED/APPROVED (CCR 2635 (b) (2)) <br /> TANK ACCESS PORTS BROUGHT TO GRADE (LOCKED AND WATERTIGHT) APT <br /> TANK INTEGRITY TEST (PASSING HARD COPY) (CCR 2635 (a) (5)) <br /> 21. MONITORING PLAN, RESPONSE PLAN AND LOG BOOK ON SITE (CCR 2632 (d)) <br /> "C" FORM COMPLETED AND SUBMITTED (CCR 2635 (d)) <br /> 23. MONITORING METHOD FOR ALL TANKS AND PIPING APPROVED (CCR 2630-2636) <br /> 24. ALL CONDITIONS MET; FACILITY PERMIT ISSUE❑ (H+S CODE 252B4) <br /> COMMENTS: <br /> EH23-006 9/95 <br /> 10 <br />