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7{ <br /> UNDERGROUND TANK INSPECTION RF.0)RD <br /> NF:W TANK INSTAI,I.ATlt1N <br />;. SITE MANE /—,r V— �— <br /> 25629/ <br /> 1 INSPECTOR'S NAME <br /> c <br /> ADDRESS 2 9/ <br /> CITY_ C� _szIP S37 <br /> CONTRIICTOR: NAME TELF.PHOME�7`/r�-5-��• <br /> OWNER: NAME <br /> TELS �1�TELEPHONE <br /> DIS— INSPECTOR'S <br /> DATE APPROVED APPROVED LMITIALS <br /> IEM OR EQUIPMENT INSPECTED <br /> 7. <br /> SNIT[Al. INSPECTION <br /> 626 1/ ! `jL- Tank tested <br /> upon deliveryTklalida lasteel) or air at SPSI FkP <br /> 2. Visual inspection of secondary containment. <br /> G ]. fank a ro riatel laced with approved backfill. <br /> 4. UL numbers and tank ca acitles recorded. <br /> r <br /> tl��fj t✓ PIPINtltimai4 <br /> INSPECTION <br /> E. Pressure test of ,t linand coed (NEPA 3f11 <br /> 2. Ball oat VaIVC3 installed. <br /> ]. overfill protection inalalled, desi rlhe: fL <br /> A-' 4. Un,.sed tank a ienln•s Sealed and cathodicalIv Protected. <br /> lt <br /> v ✓ a-r!i-- 5. Visual insvection of secondary cuntaineent an t In . <br /> �LI/ 1+ 0oorts 1 v •a an bt ou ht o rade. Ito"f$, a "erne{ proo <br /> / A4Z, 1. Fill and vent tl in hrou ht to rade. <br /> 1� jf <br /> 8. PTnduct line leak detector in place. (Hard wired) <br /> 4. 1& device installed. <br /> 7 1u All alvanieedj)kjJinjt and fittin s 2roperIX wrapped. <br /> ll. Presyrrre deca test on cumlietC tank and product. delivery s sLem..cO) <br /> / FI N,iI. I NSPFCTI ON <br /> i <br /> 1 . Precision test st"mcl-5stullY ar.tl hard in rtes recelvedNI <br /> D 7. ti,tll proleftLatt at fill .i ..•. <br /> 1. Ile, mmante tv-,i nc.•r 1111 u..r{•, r tori rvsrtra 4 <br /> 4. Pv•t I <br /> f/ .,t tua,tc t r.;r ��( rt..du, . Y i nr I.•,rw .ler ei 1 nl . (fiord wl red) -- <br /> I <br /> { 5. Pcrinrmenee test „f i.mllrw..u . e. „v1„rawv st.•mE:l an lankl:)1�+t0it.0 <br /> F <br /> Prtwll lu overate a rip Ive.iii..0 r,am .lctr. <br /> ]. Aiic tabic reeordkee in s stem. <br /> CtT�YNIS: <br />