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UNDERGROUND TANK. ]NSPECTION RF.CUND <br /> NEM TANK INSTALLATION <br /> SITE NAME (/-9j /'K YfJVI ��✓•l�l«Cyr, <br /> INSPECTUH-S NAME. L <br /> ADDRESS �U yd A-11Z5f /6/ tv C - �O'(�C� /7 ZIP / <br /> CONTRACTOR[ NAME )O''S }—L�l-F�r�/7CL /I�/'1@. TELEPHONE <br /> ONNERt NAME /�(rC�C_ ��C/�u/K/�YJ , ✓PS/7/, '7- TELEPHONE 7 O <br /> DIS- INSPECTOR' <br /> DATE APPROVED APPROVED INITIALS <br /> ITEM OR EQUIPMENT INSPECTED <br /> f. <br /> l 4&; IM_ [Al. ll1!jPECTION <br /> y�} T <br /> Tank t ted upon deliver Nollda laateel Lar air at SPSI PRP <br /> 1 � / 2. Visual Sns Ction of secondarY containstent. <br /> a- ? '✓ �� T. Tank approprlately laced with approved backfill. <br /> a. UL numbers and tank ca aclties recorded. <br /> coo / , 0 —7,3-sy q3 — (aeo r L <br /> �l <br /> RD W(; PIPING STAGE INSPECTION <br /> Pressure test of pipink. Ap�ri. ndarl JNFPA 3n)] <br /> 2, Rall oat v-11SAIns otic . <br /> 1. Uverffll protection installed. descrlltt: <br /> a. Unused tank opEntnKs scaled and cathodically protected. <br /> I1'� S. Visual inspccLLOn of secondary contalment on 1 In . <br /> I6- Motifforing "[is in place and loctob's watMr prm <br /> b't u o grad*. cwars <br /> '� ✓ 7. Pill and vent piping hrou ht to rade. <br /> ✓ '� A. Product line leak detector in place. Nord .1red) <br /> 9. Approved Lank leak monitoring device installed. <br /> IU. All malvanlxed piping and fittin s properly wrapped. N1d� <br /> ��. 1. Pressure deco test on Complete tank and product deliver • sle...5b <br /> FINAL INSPECTION <br /> V,/- K�f ✓ 1 <br /> �i�t5�-1 I � 1 . Precision tut eucc cssiull •.nl et cA ai.d hat•I i • item ree clued.��s <br /> -'I- � .v Y L ]. Sr111 rot ect loo at Itll .I •• <br /> ,�� �..� ✓ 1. Pcrfur.ancc tc::t of n,erfill not rIluu ::vat c.. <br /> A. Prrl,.anrc tr.1 of n.'dw' I ,nr I.-,k dct crtrrt . Ills rd wl reJl <br /> t1brJ <br /> f� <br /> I-•{ ✓ �� 5. Per lorunce te:a of a•nu lomu�: . nnot um st rw(:) nn tankl:)M"^II <br /> t•yv✓� 6. Pw.lt In otcr atr • t Itc. t l• u t Jetr. <br /> _.� _ IG✓ "rY ), Ar:a• table recordkee lu 5 b1%'.'^ <br /> L 46 8j \ <br /> • <br />