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UNDERGROUND TANK INSPECTION RECORD <br /> U/NEW TANK INSTALLATION <br /> Y� VV " <br /> SITE NAME `�-• 1 J s� 11 V ti ��(le INSPECTOR'S NAME I <br /> ADDRESS I(�(I p) � ��"l�l� C��f CITY I �Q.,,rA1�Ct�- CZIP � 53310 <br /> CONTRACTOR: NAME 1 rP1 UTELEPHONE 0 2 <br /> OWNER: NAME e-\� (}l�/ary ( 4 TELEPHONE �? S 7 9 <br /> DIS- INSPECTOR'S <br /> DATE APPROVED APPROVED INITIALS <br /> ITEM OR EQUIPMENT INSPECTED <br /> low dS r/ 1� <br /> o 6/ S i <br /> INITIAI. INSPECTION <br /> 1 Tank tested upon deliver Hnlida lasteel) or air at SPSI (FRP)I <br /> 2. Visual inspection of secondary containment. <br /> 3. 'rank appropriately placed with approved backfill. <br /> 4. UL numbers and tank ca acitles recorded. C C <br /> 'y��,bING TGErIN <br /> r� <br /> y�/'p��-}✓ PILSP TIO <br /> r v, 00( 1. Pressure test of piping. [Primaryand Se <br /> condar (NFPA 30)� <br /> 2. Ball float valves installed. <br /> 3. Uverfill protection installed. descrllr6: <br /> I <br /> 4. Unt:sed tank openings scaled and cathodically protected. <br /> S. Visual inspection of secondary containment on pipinK. <br /> (lockab}• weather prop <br /> n in a e and b:uu ht to rade. corers <br /> p(( 7. Fill and vent piping brought to grade. <br /> =6' ��J 8. Product line leak detector in place. (Hard wired) <br /> LI 17 9. Approved tank leak monitoring device installed. <br /> LU. All galvanized piping and fittings properly wra ed. <br /> 1. Pressure deem test on Complete tank and product, deliver s stem(NP) <br /> iFINA1. INSPECTION <br /> 4iler <br /> Precision testsucessiull Anleted and hardcrr.les received.!� 7. S til protection at fill t .r. <br /> 3. Performance t crit r.l mrerf i I I n ut er t ton ::vst Co. _ <br /> 4. Pcrfn:maucc test [ nuduir Ithe lo.rk deIccIot. (Hurd wired) <br /> 11brJ <br /> 5. Performance te::t of t•uulnuuu : m nitnttnr ti strm(s) nn tank( r^t' <br /> 6. Pe:mit to oxrate appjtc.itim, (om,leto. <br /> 7. Acceptable recordkeepitig system. <br /> ORtimrS: <br />