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irkUNDERGROUND TANK INSPECTION RECORD <br /> NEW TANK INSTALLATION <br /> SITE NAME �4�,—x-7,p)'✓ /�i�/,•?�/vi�� ��U/�jc/rl NSPECTUk'S NAME 5_ /t/lJt�l'7.f DiQ CITY57/ems 6-/h <br /> � ZIPiS,2U_s— <br /> CONTRACTOR: NAME S7ocaC�� N -T�R7/rC� �7/� Ti U�✓ <br /> TELEPHONE <br /> OWNER: NAMEn'IaLTELEPHONE <br /> DIS- INSPECTOR'S <br /> DATE APPROVED APPROVED INITIALS <br /> (TEM OR EQUIPMENT INSPECTED <br /> ftes paid. <br /> 1N_ <br /> I'r1A1. INSPEC_T10N <br /> 1. Tank tested upon delivery 1HOliday ( lasteel) or air at SPSI (FRP)I. <br /> 2. Visual ins ection of secondary containment. <br /> 3. 'rank appropriately placed with approved backfill. <br /> 1/ ✓ S 4. UL numbers and tank ca acities recorded. <br /> PIPING STAGE INSPECTION <br /> r <br /> 1. Pressure test of thin . IPrimar and Secoudar (NFPA 30)i <br /> �� 2. Ball float valves installed. <br /> - 3. Overfill protection installed, descrilhc: <br /> Y <br /> 4. Untied tank oientn s scaled and cathodically protected. <br /> 5. Visual inspection of secondary cuntaintsent on piping. <br /> cmitoring Pors in la a and brou ht to rade. (co«veai3e —ether proo <br /> {� 7. Fill and vent �i In brou ht to grade. <br /> 7 PI B. Product line leak detector in place. (Hard wired) <br /> 9. Approved tank leak monitoring device Installed. <br /> lU. All alvanited 1 In and fittings properly wrapped. <br /> 11. Pressure deca test on complete tank and produCL dcliverZ s SLem.30) <br /> FINAL I t:S)'ECT I ON <br /> I i yyt(.��t <br /> 1 . PreciSlOn lest succesSlull e-imnleted a..d ha.d ..les recetL ed(3791 <br /> 2. S.:I1 protection at till .c. <br /> 3. Performance tent .:1 overfill not e. t lnn ;:vst em. <br /> 4. Performance toyt of ptndt, Itue 1(...k detectot. (Hard wired) <br /> S. Performance te:a ..f cnntlnuuu : M1.nitnttur s st.•m(s) on tank(:)(�b;�u <br /> 6. Petsit to uwrate aplscatinn .nm .lett <br /> 7. Acceptable recordkee fu system. <br /> CCtTfTlI3: <br />