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4. <br /> UNDERGROUND TANK. TNSPECTION RFCORn <br /> NF?.TANK INSTALLATION <br /> SITE NAM>r INSPECTOR'S NAME, <br /> N <br /> ADDRESS non <br /> CITY—k�C�- _ ZIP <br /> CON'I'RACTORr NAME �} /'�y TELEPHONE 209�Q$I --�'3 <br /> OWNS; r NAME ' 0, 6 ( 64 TELEPRONF 2071- <br /> F <br /> DIS— INSPFCTnR'Sf <br /> "ATLAPPROVED APPROVED IN171AL_S__ <br /> TEM O E UTPIIFNT []aSPECTF.D <br /> �� [ INIf1AI. INSPECTION <br /> _Tank tested u n dell_very ;'Flnlfde� lastcex) ur afr aC 5P5I (PY.P)[ <br /> J 2. Vlsue7 !�nspecrlan of secondary containment. <br /> 3. Tank aeprp riaeCl lacca 1L a r-vcd backfill. <br /> C S. <br /> UL numAers and tank ra acitles recordert, Q �� <br /> PIPING STAGE INSPF.CT'ON <br /> P (/ 1. Preaturc Eest of vininy [priraarr and Srcondar (NFPA 30)1 <br /> 2. RaI! float valves tnstallcd_ <br /> 3. Vverltll prott:t:tlrrn Inst:sllcd, descri"" d <br /> ( C A• llncetd—[ank o .n!n s scaled 4nd CAthOdtCally Protected. <br /> S, Ylaual ins�icclton of _.rrr�ndar �nntairraxnt n 1 to <br /> ILI <br /> i]exhehl•4 �ther prop.�..T1^J.l�.C2r.J�,tr a and__6t >ur.ht__tu t[rrde. cowry <br /> 7. %iNl and v_ent�!>Yfn,e hrau ht to rade, <br /> M. Pr«duct P ne leak detector In lace. (Hard t+lrtd) <br /> I / 9, A proved tank lcala monitorin dcvlce tnstalled, <br /> � lU_ All palvanlred ! in and ftttfn s rr: rrl vra � ed. <br /> _- �. �� 1, Presserre decal teat on tn� 301 <br /> lete tank and product deliver s etew(V:fp <br /> p(L FINAL TtGSPF.CTION_ <br /> /r`//( ✓ I I.' Pret4slnn test succi ssful��..rnlctvd ,i,,,t t,atd c,1,les recetved l�'_,r <br /> f 17_. S2111 Urnt cr--[too at f i l l i „•, w <br /> 3. Pcr(armance test or nc.trf i It rrntrrt taa rvst Cm. " <br /> i• Prrfnrgane „1 p, der, Frnr l.•.k dctectnt- (Hord w1rcJ) I <br /> 5. Pcr(or.rancr �e:rt��f a,�nt—hw.,u•c W,�,.,,i r r.r t n,- ti• c,.•m(s) nn r onk(:)ty+t°:� <br /> (+. Prtwlt te, o}Kratr aP�lic:rrl.,r, ,+a�,irtr. <br /> )• Ac.c tablr a rr.cn•dke� tL" sy,te,,, <br />