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4 <br />UNDERGROUND TANK.INSPECTION RECORD <br />NEW TANK INSTALLATION <br />SITE NAME `� f <br />— - -�'� °"� -�-f m, ®4I INSPECTOR'S NAMF: <br />ADDRESS <br />CITY( ZIP Q <br />CONTRACTOR: NAME TELEPHONE <br />OWNER: NAME TELEPHONE <br />I I DIS- I INSPECTOR°S) <br />DATE APPROVED APPROVED tNtTrerc <br />0 <br />(TEM OR EQUIPMENT INSPECTED <br />INITIAL INSPECTION <br />1. Tank tested upon deliver Holida lasteel) or air at 5PSI (FRP)j, <br />- 9 <br />hatd co.ies received Gl <br />TA1 (7. <br />2. Visual inspection of secondary containment. <br />2, Ball float valves installed. <br />3. Tank appropriately placed with approved backfill. <br />3. <br />3. uverfill protection installed, descrihd: <br />0 <br />4. UL numbers and tank capacities recorded. <br />4, <br />PIPING STAGE INSPECTION <br />I. Pressure test of ri>in (Primary and Secondary (NEPA 30)) <br />- 9 <br />hatd co.ies received Gl <br />TA1 (7. <br />2, Ball float valves installed. <br />( <br />3. <br />3. uverfill protection installed, descrihd: <br />0 <br />4, <br />Perf:umance tell .,f nudwi -line 1#•ak detectot. ((Hard wired) <br />C <br />6. Unt;sed tank openings scaled and cathodically protected. <br />Performance te:;t of c.auinuuu•: m..uitorinr <br />1 bpd <br />system(s) on tank(!,..).,- -#) <br />f. <br />Permit to operate a,p licatiou rom.lcte. <br />5. Visual ins ection of secondary containmeot on PiL)jnfr. <br />6. ( iockabio `mother prop <br />•o r 5 to I.C.- and bruu ht to rade. covers l) <br />Acceptable recordkee io s stem. <br />1. Pill and vent piping brought to gradop..Si <br />q� <br />8, Product line leak detector in place. (Hard wired) <br />9. Approved tank leak monitorin& device installed. <br />10. All galvanized pipinK and fittings properly wrapped. <br />�y� <br />1. Pressure decay test on comulece tank and oroduct delivery %vat-11y,//��, <br />FINAL INSPECTION <br />Precision test succesSiull c..mnleted and <br />- 9 <br />hatd co.ies received Gl <br />TA1 (7. <br />Still rot ect ioo at. fill .i .r. T <br />3. <br />Performance test .:I overfill u.n er t ion ::vst cm <br />4, <br />Perf:umance tell .,f nudwi -line 1#•ak detectot. ((Hard wired) <br />C <br />5, <br />Performance te:;t of c.auinuuu•: m..uitorinr <br />1 bpd <br />system(s) on tank(!,..).,- -#) <br />f. <br />Permit to operate a,p licatiou rom.lcte. <br />7. <br />Acceptable recordkee io s stem. <br />