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�.. UNDERGROUND TANK INSPECTION RECORD <br /> NEW TANK INSTALLATION <br /> SITE NAME <br /> �C �z' 1'� V �yNCy– INSPECTOR'S NAME <br /> t7\..ADDRESS — � C <br /> CONTRACTOR: NAME ZIP S E <br /> \ / / <br /> OWNER: NAME NONE_ �!_ e�lU(�j� PIG)l�l� � VI <br /> --� PHONE <br /> i <br /> DIS SPECTOR'S <br /> �y DATE PPROVED PPROVED INNIrIALS <br /> ITEM OR EQUIPMENT INSPECTED <br /> Fees paid <br /> . <br /> Plans Approved <br /> // ? INITIAL INSPECTION <br /> {� 1. UL numbers (��- �J���t;�i�� tank size 7 <br /> ;�/ O Tank tested upon delivery (Holiday (plastcel) o Ir at S Ps <br /> (FRP) <br /> V u/�IY�lA <br /> S. Visual inspectjon Q4,secondaryc to irrnen[. /�_/2�_rr,l '1/�Gcz <br /> Tank appropriately placed with approved backfill. <br /> 'IPING STAGE INSPECTION <br /> // 1. Pressure [est of piping. [primar and econdar <br /> y (NEPA 30)] <br /> 2. Hatt float valves installed. <br /> 3. Overfill protection installed, describe: <br /> 22 4• Unused tank opening sealedand cathodicall <br /> y protected. <br /> S. Visual inspection of secondary contairiknt on piping. <br /> 6. Monitoring ports in place and brought to <br /> grade. (lockable weather proof covers) <br /> 1 7, fill and vent piping brought to grade. <br /> J d 0. Product line leak detector in place. (Hard wired) <br /> 9. Approved tank leak monitoring device installed. <br /> 0. ALL galvanized piping and fittings g properly wrapped. <br /> 11. Pressure decay test an coNpLete tank and product delivery systnn. <br /> INAL INSPECTION <br /> 1. Precisian test successfully completed and hard copies received. (NFPA 329) <br /> 2. Spill protection at fill pipe. <br /> 1 ( 3. Performance test of overfill protection System. <br /> 4. Perfornwnce test of product line leak detector. (Hard wired) <br /> Ir 5. PerfornnNlce test of continuous ngnitoring sys[mm(s) On tank (s) <br /> 6. Permit to Operate application cnaptete. <br /> l (/v 7. Acceptable recordkeepjnq system. <br /> Canments: <br /> EN 23 006 10/09 <br />