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UNDERGROUND TANK INSPECTION NECORD <br /> NEW TANK INSTALI.ATION p j <br /> SITE NAME cR <br /> L1 INSPECTOS NAMEF^ <br /> _ �JAI �E vi LA <br /> • ADDRESS_ �CQ /' CITY <br /> LIP <br /> CONTRACTOR, NAME hA2F�� �(' C( )(t•h �(^] TEL.PTON— <br /> OWNER, <br /> ON /S S <br /> OWNER, NAME <br /> TELEPHONE <br /> DIS- INSPECTOR'S — <br /> DATE APPROVED APPROVED INITIALS <br /> (/ ITEM OR EQUIPMENT INSPECTED <br /> INITIALINSPECTION <br /> 1. Tank tested u n deliver [Holiday lasteel) ur air at 5PSI PRP <br /> 2. Visual inspection of secondary containment. <br /> __L"_j&_11k_a2I!ropriate1Y placed with apprinved backfill. <br /> ' 4. UL numbers and card ca ac Maes recordeA. <br /> PIPING STAGE INSPECTION <br /> I. Pressure test of 1,ijAny.. IFIrlmaryand Secondary (NFPA 70)j <br /> Ball ( oat valves Installed. <br /> 1. Ovcrflll protection inslalled• desrrlhc: <br /> 4• Unused tank orentn's scaled and cathodical) rutected. <br /> 5. Visual Ins ectlun of secondary containment on piping. <br /> nollitoring porre, lit and b,ou ht to Arade. (leixilile watMr Prop <br /> 7. Fill and vent otping brow ht to grade. i <br /> 8. Product line leak detector in place. (Hard wired) <br /> 9_ A roved tank leak moniturrng device Installed. <br /> lU. Ali italvallized t)iping and fttliu s ro crl wra cd. <br /> Il. Pressure del test on cOm Iete Lank and product delivery s stemIP1 <br /> FINAL I Ia I'F.CT I GN <br /> 1 {� <br /> I . Precision test succ. snlull ,Lal eted nod IwN i .des reectved 15795 <br /> 7. Sill ro,ecttou :rr I <br /> 1. Per(ormanic rt•+r c.•,f l l l n .r r. r u.0 ::vv cm. <br /> 4. 1'rrl.a rueu<c n^.r ..f Ir„du. . I,nr Io.rk ,Icr cel Lal . lila rd wl redr _ <br /> 1. Performance tern (of t.vrl lnu.m'. nnlnr urr st rm tb��lar s) mr tank(:)�t <br /> A. V.vmlt Ur u ,cr ale at Ir , i.n, ,um,Icer. <br /> 1. Acce table recordkee Ln s .tem. <br /> oorf"S: <br /> ... ::..tr.. at .. ... <br />