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. s • <br />UNDERGROUND TANK INSPECTION RECORD <br />NEW TANK INSTALLATION <br />SITE NAME _�ry INSPECTOR'S NAME <br />ADDRESS 90 CITY ZIP <br />CONTRACTOR: NAME GAJ a d a EPHONE <br />OWNER: NAME d `I TELEPHONE <br />DATE. APPROVED <br />DIS- INSPECTOR'S <br />APPROVED INITIALS <br />(,TEM OR EQUIPMENT INSPECTED. <br />777 PIPING STA,E [NSP ION <br />1. Pressure test of t)ing. (Primary and Secondary (NFPA 30)) <br />llB'nCC %AIZ /fir FINAV INSPECTION <br />(W( 1-z�9-3/G p" <br />etved <br />11. recision test successtuLl ,.,moleted and hard co,les rec��z4i <br />q111 <br />Spill prot ect ion at. till i,r. <br />Tank tested <br />LN_ ITIAI. INSPECT -ION <br />upon deliver Hnlida lasteel) or air at SPSI (FRP)i <br />-�� <br />17 - <br />2. <br />ow I <br />rr <br />N+'3 <br />777 PIPING STA,E [NSP ION <br />1. Pressure test of t)ing. (Primary and Secondary (NFPA 30)) <br />llB'nCC %AIZ /fir FINAV INSPECTION <br />(W( 1-z�9-3/G p" <br />etved <br />11. recision test successtuLl ,.,moleted and hard co,les rec��z4i <br />r/ <br />2. Ball float valves installed. <br />Spill prot ect ion at. till i,r. <br />Tank tested <br />LN_ ITIAI. INSPECT -ION <br />upon deliver Hnlida lasteel) or air at SPSI (FRP)i <br />-�� <br />17 - <br />2. <br />Visual inspection <br />of secondary <br />containment. <br />49 <br />J. <br />Tank appropriately <br />placed with <br />approved backfill. <br />Acceptable recordkee in system. <br />4. <br />UL numbers <br />and tank capacities <br />recorded. <br />t0_All galvanized piping and fittings properly wrapped. <br />ll. Pressure decaytest on complete tank and product deliver s stem�3�1 <br />ow I <br />rr <br />N+'3 <br />777 PIPING STA,E [NSP ION <br />1. Pressure test of t)ing. (Primary and Secondary (NFPA 30)) <br />llB'nCC %AIZ /fir FINAV INSPECTION <br />(W( 1-z�9-3/G p" <br />etved <br />11. recision test successtuLl ,.,moleted and hard co,les rec��z4i <br />r/ <br />2. Ball float valves installed. <br />Spill prot ect ion at. till i,r. <br />3. overfill protection installed, describe: <br />Performance fest 01 ovcrf i 11 n w t•, r ion evst cm. <br />17 - <br />Unused tank openings scaled and cathodical) rotected. <br />Pei(:,emance tez;t .,f nodus 11ite Ieak deIcctot. (liard wired) <br />'1—gk- <br />Visual inspection of secondar containment on 1 in . <br />�yv <br />ff <br />(lockable weather prop <br />n It place and bcuu ht to rade. covers <br />/on <br />- (r <br />7. Fill and vent piping brought to grade. <br />Acceptable recordkee in system. <br />Product line leak detector in place. (Hard wired) <br />9._A roved tank leak monitoring device installed. <br />t0_All galvanized piping and fittings properly wrapped. <br />ll. Pressure decaytest on complete tank and product deliver s stem�3�1 <br />OGHMWrS <br />'rll.'r�J <br />llB'nCC %AIZ /fir FINAV INSPECTION <br />(W( 1-z�9-3/G p" <br />etved <br />11. recision test successtuLl ,.,moleted and hard co,les rec��z4i <br />r/ <br />7. <br />Spill prot ect ion at. till i,r. <br />3. <br />Performance fest 01 ovcrf i 11 n w t•, r ion evst cm. <br />17 - <br />4. <br />Pei(:,emance tez;t .,f nodus 11ite Ieak deIcctot. (liard wired) <br />'1—gk- <br />5. <br />l�ta rJ <br />Performance te:;t of 4.owinuuu:c r„„n,itorin' s sinm(::) On tank(s)l+ip^,tp <br />6. <br />Prrmit T o trate ap licat(on com,lete. <br />Acceptable recordkee in system. <br />OGHMWrS <br />'rll.'r�J <br />