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\ NEW UST INSTALLATION RECORD <br /> FACILITY NAME h I l.' D <br /> i m Li A I iZ z3 I/ci a <br /> FACILITYADDRESS Z45 Cd. . Vj2i -Q[)Aj-) , [-n-pi <br /> SWEEPS # TANK# Z U.L. # PRODUCT AVIFFTI/w IFL <br /> DATE APPROVED DISAPPROVED RENS ITEM OR EQUIPMENT INSPECTED <br /> p131. UST INSTALLATION PLANS SUBMITTED & FEES PAID <br /> Q� f 2. UST INSTALLATION PLANS APPROVED <br /> INITIAL INSPECTION <br /> y 2Z I K y y <br /> 1. HOLIDAY TEST (PLASTEEL) <br /> 7l�la Kp,0` 2. AIR TESTED @ 5 PSI (FRP) <br /> Y12 91 <br /> Kc.0. 3. VISUAL INSPECTION OF 20 CONTAINMENT <br /> yY2 N F`yf 4. TANK APPROPRIATELY PLACED WITH APPROVED BACKFIE7 5'U <br /> PIPING STAGE INSPECTION / <br /> 5 <br /> KW I. PRESSURE TEST (10 AND 20 PSI (FRP)] l _@iSr( P5, <br /> -�j M P((ewlK V 2. BALL FLOAT VALVES INSTALLED I <br /> i <br /> 3. OVERFILL PROTECTION INSTALLED, DESCRIBE: �,le—jt4f7V HE/.�r <br /> AAN OAY,5�, J&J, A- aj-r r� <br /> 4. UNUSED TANK OPENING SEALED & CATHODlCALLY PROTECTED <br /> SIw V� �v I <br /> S. VISUAL INSPECTION OF 20 CONTAINMENT ON PIPING <br /> 6. MONITORING PORTS IN PLACE & BROUGHT TO GRADE (LOCKABLE <br /> WEATHER PROOF COVERS) <br /> y ti I E py fi 7. FILL &VENT PIPING BROUGHT TO GRADE <br /> Q9 93 V,' PV"rf B, PRODUCT LINE LEAK DETECTOR INPLACE (HARD WIRED) <br /> 91 <br /> 33 9. APPROVED UST LEAK MONITORING DEVICE INSTALLED <br /> 10. ALL GALVANIZED PIPING &FITTINGS PROPERLY WRAPPED <br /> 11. PRESSURE DECAY TEST ON COMPLETE UST& PRODUCT DELIVERY <br /> FINAL INSPECTION <br /> 1 / 1. PRECISION TEST SUCCESSFULLY COMPLETED AND HARD COPIES <br /> RECEIVED (NFPA 329) <br /> 9C)2j (Vv'rXl= 2. SPILL PROTECTION AT FILL PIPE <br /> 3. PERFORMANCE TEST OF OVERFILL PROTECTION SYSTEM <br /> 4. PERFORMANCE TEST OF PRODUCT LINE LEAK DETECTOR (HARD <br /> WIRED�o be z,-4,, j b)(ftsf co re5.16 5,b,-.,4a � END �/� rjh3 <br /> 5. PERFO CE TEST OF CONTINUOUS MONITORING SYSTEMS) ON <br /> TANK(S) Sav <br /> 6. PERMIT TO OPERATE APPLICATION COMPLETE <br /> 7. ACCEPTABLE RECORD KEEPING SYSTEM <br /> EH 23 0 4' - <br /> 9/9/�3 �M5 <br />