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UNDERGROUND TANK INSPECTION RECORD <br /> ' NEW TANK INSTALLATION <br /> SITE NAME �• TINSPECTTO/R'S NAME <br /> /��/ <br /> ADDRESS ') Q�i -��'7�t rsrl ee s--e�n _ CITY T J [ /L Y Z7YZ-i 21P <br /> CONTRACTOR: NAME PHONE <br /> OWNER: NAME PHONE <br /> � a <br /> D[S INSPECTOR'S <br /> DATE kPPROVED kPPROVED INITIALS <br /> ITEM OR EQUIPMENT INSPECTED <br /> Fees paid <br /> Plans Approved <br /> INITIAL INSPECTION <br /> . UL numbers tank size <br /> Tank tested upon delivery [Holiday (ptasteel) or air at 5 PSI (FRP)] <br /> S. Visual inspection of secondary containment_ <br /> Tank appropriately placed with approved backfitl. <br /> fl <br /> IPING STAGE INSPECTION <br /> S�rr(4t41. Pressure test of piping. [Primary and Secondary (NFPA 30)I <br /> C -fO2. Sall float valves installed. <br /> �J <br /> 3. Overfill protection installed, describe: <br /> ir <br /> 4. Unused tank opening sealed and catholically protected. <br /> lMi �, S. Visual inspection of secondary containment on piping. <br /> �� <br /> �3 C C2. 6. Monitoring ports In place and brought to grade. (lockable weather proof covers) <br /> 1�11� T. Fill and vent piping brought to grade. <br /> 8. Product tine leak detector in place. (Hard aired) <br /> 9. Approved tank leak monitoring device installed. <br /> 0. All galvanized piping and fittings properly wrapped. Fi�, << lit_ <br /> 1. Pressure decay test on complete tank and product delivery system. <br /> hFINAL INSPECTION <br /> 1. Precision test successfully completed and hard copies received. (NFPA 329) <br /> 2. Spill protection at fill pipe. <br /> 3. Performance test of overfill protection system. <br /> 4. Performance test of product line teak detector. (Hard wired) <br /> 5. Performance test of continuous monitoring system(s) on tank (s) <br /> 6. Permit to operate application complete. <br /> 7. Acceptable recordkeepirg system. <br /> EH 23 006 10/89 <br />