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0 0 <br />UNDERGROUND TANK INSPECTION RECORD <br />NEW TANK INSTALLATION <br />SITE NAME S1teR INSPECTOR'S NAME <br />,,—ADDRESS 2 3 � CITY ZIP <br />CONTRACTOR: <br />NAME <br />PHONE <br />OWNER: <br />NAME `/ L ���[IZ���� <br />PHONE <br />PPROVED <br />39- 14x-�,V - off'. <br />�1\1f <br />DIS <br />INSPECTOR'S <br />. Tank tested upon delivery [Holiday (ptasteet) or it a 5 PSI (FRP)l <br />DATE <br />PPROVED <br />PPROVED <br />INITIALS <br />f <br />4. Unused tank opening sealed and cathodicatly protected. <br />/9 <br />3. Performance test of overfill protection system. <br />ITEM OR EQUIPMENT INSPECTED <br />1. Fees paid <br />6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />1110! <br />P. Plans Approved <br />39- 14x-�,V - off'. <br />�1\1f <br />., <br />TIP, <br />1 P <br />/' INITIAL INSPECTION Pdj <br />. UL numbers azjj 3 - j tank size <br />. Tank tested upon delivery [Holiday (ptasteet) or it a 5 PSI (FRP)l <br />. Visual inspection of secondary containment. <br />. Tank appropriately placed with approved backfill. <br />/ <br />IPING STAGE INSPECTION <br />1. Pressure test of piping. [Primary an Seo any NFPA 30)) <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />2. Balt float valves installed. <br />K!�— <br />3. o rfi l rotection i tatted, describe: <br />C LD <br />g <br />4. Unused tank opening sealed and cathodicatly protected. <br />/9 <br />3. Performance test of overfill protection system. <br />5. Visual inspection of secondary containment on piping. <br />6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />1110! <br />7. Fitt and vent piping brought to grade. <br />✓ <br />8. Product line leak detector in place. (Hard wired) <br />6. Permit to operate application complete. <br />9. Approved tank leak monitoring device installed. <br />u , <br />CV 10. All galvanized piping and fittings property wrapped. <br />11. Pressure decay test on complete tank and product delivery system. <br />i/ <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />K!�— <br />2. Spill protection at fill pipe. <br />g <br />3. Performance test of overfill protection system. <br />4. Performance test of product line leak detector. (Hard wired) <br />1110! <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 />