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UNDERGROUND TANK INSPECTION RECORD 16 <br />NEW TANK INSTALLATION <br />SITE NAME INSPECTOR'S NAME ClVrIeS 11UA,74 <br />`.-ADDRESS I / CITY Z .11, zip q5A to <br />CONTRACTOR: NAME % .r (bl� PHONE 16 A 96 7 7</.Zfj <br />OWNER: NAME q -r-, c ell PHONE kP,�, A4, r>& ®Z -95+., - f <br />ITEM OR EQUIPMENT INSPECTED <br />. Fees paid <br />F. Plans Approved <br />g <br />lei, <br />V <br />I I <br />C <br />eff <br />%w C. INITIAL INSPECTION <br />. UL numbers 2.11177 tank size <br />. Tank tested upon delivery (Holiday (plasteet) or air at 5 PSI (FRP)l <br />3. visual inspection of secondary containment. <br />. Tank appropriately placed with approved backfill. <br />Comments: <br />EN 23 006 <br />PIPING STAGE INSPECTION / L �r°c� 7777 <br />1. Pressure test of piping. (Primary and Secondary (NFPA 30)) <br />2. <br />Balt float valves installed. <br />3. <br />Overfill protection instalted, describe: <br />4. <br />Unused tank opening sealed and cathodicalty protected. <br />5. <br />Visual inspection of secondary containment on piping. <br />' <br />6. <br />7. <br />Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />Fitt and vent piping brought to grade. <br />a. <br />Product line leak detector in place. (Hard wired)���#� <br />9. <br />Approved tank leak monitoring device instalted. <br />0. <br />ALL galvanized piping and fittings properly wrapped. <br />— <br />. <br />Pressure decay test on complete tank and product delivery system. <br />Comments: <br />EN 23 006 <br />INAL INSPECTION <br />1. AzIFision test successfully completed and hard copies received. (NFPA 329) <br />2. <br />Spill protection at fill pipe. <br />3. <br />Performance test of overfill protection system. <br />4. <br />Performance test of product line leak detector. (Hard wired) <br />S. <br />Performance test of continuous monitoring system(s) on tank (s) <br />6. <br />Permit to operate application complete. <br />7. <br />Acceptable recordkeeping system. <br />Comments: <br />EN 23 006 <br />