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UNDERGROUND TANK. TNSPECTION RECORD <br /> NEW TANK INSTAI.I.ATION <br /> SITE NAME_ INSPECTOR' NAMEj1� <br /> ADDRESS_ �lh�l�tlCaTDlI( �( CITY `,�`CJCr'�<6 ZIP 2(J <br /> CONTRACTOR t NAME <br /> TELEPHONE <br /> OWNER: NAME <br /> TELEPHONE <br /> DIS- INSPECTOR'S <br /> DATE APPROVED APPROVED INITIALS <br /> ITEM OR EQUIPMENT INSPECTED <br /> ✓ INITIALINSPECTION <br /> II (Z 1. Tank tested u n deliver Hnlida ( lascecl) or air at SPSI (FRP)j, <br /> 1!/Y� 2. Visual ins ection of secondary containment. <br /> 'LA 3. 'tank appropriately placed with approved backfill. <br /> I��� 4• UL numbers and tank ca acitles recorded.____ <br /> PIPING STAGE INSPECTION <br /> Ill ? ✓ G I f1 1. Pressure test of piping. <br /> lPrimary and Secondary (NEPA 30)1 <br /> 1a13� ✓ I I �r� 2. Ball float valves installed. <br /> f'► 3. overfill protection installed. descrlh6: <br /> 'jam{ V <br /> d. Unt:sed tank openings scaled and cathodically protected. <br /> 5. Visual inspection of secondary containment on pipinK. <br /> (L otoring Ports in Place and btou ht to rade. (coovvsa5le wether prop <br /> V �` 1. Fill and vent piping brought. to grade. <br /> al jL_ 8. Product line leak detector in place. (Hard wired) <br /> I✓ Mat— 9. Approved tank leak monitoring device installed. <br /> 1)�vv lu. All galvanired pi ing and fittings properly wrapped. <br /> decay test on complete tank and product delivery system. <br /> i <br /> FINAL INS PECTION <br /> vlY' <br /> I .' Precision lest suc"-ssiull �..�unlctcd .11,d hats co des received���s <br /> r 21 V I 4 t 7. Spill r tett ion .it fill 1.11w. <br /> N 3. Performance test r.: nverfiII n.rtertton :,vstem. <br /> v IJL 4. Perfn[menee ttst o[ nod u. . line• Ie•tk dctectut. (Hurd wired) <br /> t bro <br /> 5. Performance te::t of tontinuuu: m.mitnttm ti st.•m(s) nn Iank(s)P.r.•.0 <br /> 6. Petmit to o)erste a , 1 teat iou om,lett•. <br /> 7. <br /> Acceptable recordkee in s btem. <br />