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UNDERGROUND TANK INSPECTION RECORD J / " 2— <br /> NEN TANK INSTALLATION <br /> SITE NAME / G <br /> .ADDRESS 7 j �j S� INSPECTOR'S NAME <br /> P G � l�IIP ary <br /> CONTRACTOR; NAME <br /> 21P <br /> OWNER: A ` YT�NER: NAME _ \'!✓�'Il V.V PHONE Fr (.(.l�n'l \ �{J. <br /> St 4 PHONE <br /> R'S <br /> IffIETPaid <br /> LS <br /> ITEM OR EQUIPMENT INSPECTED <br /> 1. Fees,/ paid 17�/WS Plans Approved <br /> >/ /IINITIAL INSPECTION <br /> Z/ � iC// I. UL numbers UL 3.6 �,r4 ) <br /> tank size _ <br /> O )/ 6i Tank tested upon delivery [Holiday (ptasteet) or ai at 5 PSI (FRP)) <br /> S. visual inspection of secondary containaent. <br /> I < Tank aPproprio[ely placed with approved backfill. <br /> IPING STAGE INSPECTION ry (2-( <br /> 1. Pressure [est ofpiping. Sp9( ( Pfj�� <br /> [Prinury and Secondary (NFPA 30)) <br /> 2. Doll float valves Inws railed. 1 �� <br /> 3. Overfill protection installed, describe: <br /> 4. Unused tank opening seated and cathodical) <br /> y Protected. <br /> /�✓ 5. Visual inspection of secondary containaent on piping. <br /> 6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br /> 7. Fill and vent piping brought to grade. <br /> fit/! <br /> B. Product line leak detector in place. (Hard wired) <br /> 9. Approved tank leak nnnitoring device installed. <br /> All galvanized piping and fittings properly wrapped. <br /> 11. Pressure decay test on Caiplete tank and product delivery systan. <br /> 'HAL INSPECTION <br /> 1. Precision test successfully Completed and hard copies received. (NfPA 329) <br /> 2. Spill protection at fill pipe. <br /> Perfonwwnce test of overfill protec[ion system <br /> q1 '�� ✓ 4. Perfornwnce test of product line leak detector. (Hard wired) <br /> IJ 5. Perfornwnce test of continuous nnnitoring systaa(s) on tank (s) <br /> 6. Permit to operate application coaplete. <br /> 7. Acceptable recordkeepinvg system. <br /> Coumen[s• <br /> EH 2I 006 10/49 <br />