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UNDERGROUND TANK INSPECTION RECORD <br /> ,"� <br /> NEW <br /> '•TAAN�K`��INSTALLATION <br /> SITE NAME TA <br /> _ ) `{ �`I.VOW +� �\�'" S G tiy" '\,/V'✓`F <br /> ...ADDRESS INSPECTOR'S NAME-- I S 3 cJ C CITY / �— 21P 9s- - <br /> CONTRACTOR: NAME <br /> q _ PHONE <br /> OWNER: NAME I.J <br /> 1 PHONE <br /> DATE PPROVED PPROVED DIS INSPECTOR'S <br /> S <br /> ITEM70REQUIPMENT INSPECTED <br /> 1. Fees paidDUiU"I�� <br /> Plens Approved <br /> /O INITIAL INSPECTION /� <br /> oI 1. UL numbers _GG L.�t(� /�3� tank size lc <br /> Tank tested upon delivery [Holiday (plasteet) OKCir at 5 Psi (FRP <br /> Visual inspection of secondary containment. <br /> f 7 v G✓" Y/ <br /> . Tank appropriately placed with approved backfill. <br /> ]PING STAGE INSPECTION 1F/ OP51 <br /> 3 ✓ /q/ 1. Pressure test of piping, ri maryand ondary (NFPA530)) <br /> 2. Ball float valves installed. <br /> 3. Overfill protection installed, describe: <br /> 4. Unused tank opening sealed and cathodically protected. <br /> 5. Visual inspection of secondary containment an piping, <br /> -------------- <br /> ,�3 G✓w 6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br /> h 7. F[ll and vent piping brought to grade. <br /> p B. Product line leak detector in place. (Hard wired) <br /> �0 <br /> V. Approved tank leak monitoring device installed. <br /> ♦� G/ 0. All galvanized piping and fittings properly wrapped, <br /> 1. Pressure decay test an Mip(ete tank and product delivery system. <br /> INAL INSPECTION <br /> 1. Precision test successfully completed and hard copies received. (NFPA 329) <br /> 1 2. Spill protection at fill pipe. <br /> 3. Performance test of overfill protection system. <br /> 4. Performance test of product line leak detector. (Hard wired) <br /> 1 S. Performance test of continuous monitoring system(s) on tank (s) <br /> / 6. Permit to operate application complete. <br /> /r 7. Acceptable recordkeeping system. <br /> Comments: <br /> EH 23 006 10709 <br />