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SITE NAME _ CZVk-,- � <br />'- ....ADDRESS A <br />CONTRACTOR: NAME <br />OWNER: NAME / <br />0 0 <br />UNDERGROUND TANK INSPECTION RECORD <br />NEW TANK INSTALLATION <br />INSPECTOR, S NAME _ _ / ilk G, C/• <br />%o ZIP <br />p ' PHONE <br />PHONE <br />7j1 <br />101 <br />DIS <br />INSPECTOR'S <br />j g L� INITIAL INSPECTIONrr�j,e <br />1. UL numbers (,� (/� tank size ( s <br />DATE <br />kPPROVED <br />PPROVED <br />INITIALS <br />�����0 <br />/ <br />3t <br />7 � <br />ITEM OR EQUIPMENT INSPECTED <br />1. Fees paid <br />LIYZ?o,i <br />- <br />4. Unused tank opening sealed and cathodicalty protected. <br />Plans Approved <br />P. <br />7j1 <br />101 <br />PIPING STAGE INSPECTION <br />1. Pressure test of piping. [Primary and804�FPA 30)] <br />j g L� INITIAL INSPECTIONrr�j,e <br />1. UL numbers (,� (/� tank size ( s <br />. Tank tested upon delivery [Holiday (plasteet) ortic 5 PSI FRP)] <br />. Visual inspection of secondary containment. <br />. Tank appropriately placed with approved backfill. <br />VVIZ <br />2. Batt float valves installed. <br />/ <br />IgWb` <br />PIPING STAGE INSPECTION <br />1. Pressure test of piping. [Primary and804�FPA 30)] <br />$� <br />2. Spill protection at fill pipe. <br />VVIZ <br />2. Batt float valves installed. <br />/ <br />3t <br />3. 0 er ilt protecti n installed, describe: O L <br />4. Performance test of product line leak detector. (Hard wired) <br />4. Unused tank opening sealed and cathodicalty protected. <br />4Sjq6 <br />5. Visual inspection of secondary containment on piping. <br />6. Permit to operate application complete. <br />6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />7. Acceptable recordkeeping system. <br />7. Fill and vent piping brought to grade. <br />?� <br />8. Product line teak detector in place. (Hard wired) <br />t <br />9. Approved tank leak monitoring device installed. <br />7"d <br />10. All galvanized piping and fittings property wrapped. <br />1. Pressure decay test on complete tank and product delivery system. <br />IgWb` <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />$� <br />2. Spill protection at fill pipe. <br />VVIZ <br />Kq <br />3. Performance test of overfill protection system. <br />3t <br />4. Performance test of product line leak detector. (Hard wired) <br />5. Performance test of continuous monitoring system(s) on tank (s) <br />6. Permit to operate application complete. <br />7. Acceptable recordkeeping system. <br />Comments: <br />