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Nov 02 08 05:00p Elite Iv Contractors Inc 2094616342 p.2 <br />�'• fr • .. ,� r d G66]/66V.RG V>� TVSr-.IYa.v s .aw. ��v�� -rvv .r 'rdr rr �•V. � •�•••,� •• ••-•Yt.6i•-::-' e <br />UNDERGROUND STO.PAGE WSW ST PROG R SERVICE 14bVEST INSPEC'T'ION REPORT <br />Facility Name: j Inspection Date: f <br />Facility Addt. Request_ <br />Gam. f ®A� 52 <br />p' 'Onsite tiervice Technldan's Name: <br />]CC Service rrechiiician/instaiicr Certification. #: Mlanufacturcr'1'raining: <br />W1 Qb3�7&WP.CM1Z <br />SER'V'ICE <br />•� <br />1 - fid .(. �/y'r� �rC•4t `�,/�. ����!"r..•"• . <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test proEZamrncd <br />C3 <br />•Ld etector _.-....-_..._ .. <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial ft: <br />❑ <br />•❑ line test grogammed <br />Leak detector <br />® <br />O mechanical Model: <br />❑ <br />❑ electronic Serial' #: <br />._._❑ .lixre-test al .. . <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ Fail safe Serial #: <br />❑ NA <br />sensor <br />® <br />❑ positive shutdown, Model: <br />❑ fail safe Serial #: <br />❑ <br />NA <br />❑ <br />r❑ <br />❑ <br />❑ positive shutdown Model: <br />❑• fail-safe. Serial' #.,- _-- __-- <br />❑ NA <br />r.-.- Drop tube with mechanical -overfill at 95% <br />® <br />Drop tube with mechanical overfill at 95% <br />D <br />Overfill prevention (see LG -letter 150-1) - - - - - - <br />SERVICE <br />•� <br />1 - fid .(. �/y'r� �rC•4t `�,/�. ����!"r..•"• . <br />�.��45i11 bucket 9 -minimum 5 gallon <br />/y'.'U"✓ <br />� <;%o er,J...r. � �1 i i .r l i � �r . � ✓ :�I.�' �^�ijr�,f•�r <br />�C 1 hour hydrostatic In incon TS -STS <br />❑ Caldwell System 0 Other <br />Spill bucket ❑ riiinimum 5 gallon <br />C3 <br />0 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />O 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes. <br />Secondary piping testing at: <br />❑ <br />pS1 <br />minutes <br />.. w1v * <br />Secondary containment repairs for: <br />❑ <br />VDC(s), Piping <br />Sumps) UST(s) <br />❑ <br />. Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: s66below' <br />� 6 '�a�d. � r ��rri <br />•� <br />1 - fid .(. �/y'r� �rC•4t `�,/�. ����!"r..•"• . <br />`B-'k� <br />� <br />r�ti l bar, �i [� r ��.%' �! <br />/y'.'U"✓ <br />� <;%o er,J...r. � �1 i i .r l i � �r . � ✓ :�I.�' �^�ijr�,f•�r <br />1 THIS FACit.fT Y"IS'•SUBJECT TO..REtNSPECTION AT. ANY TIME AT_ •p'S_CURRENT. . Y TE. <br />El•itv�: �!' %rr r ��'t , .�/� c """ a very: tl4t. � ....__.. _. . <br />q:�• f. r4 <br />SHE) 23-04f1 <br />Rev 06122/07' Y <br />UNTY <br />We will add finance charges on invoices more than 30_jkWN M.WAL <br />T <br />