Laserfiche WebLink
FORM AF2 <br /> INSPECTION AFFIDAVIT <br /> To: Owner of underground storage tank located at <br /> 1, the undersigned, hereby <br /> swear and attest that all work was performed on the above designated tank in accordance with <br /> Chapter A of NLPA 631 and the following: <br /> 1) The tank met the structural qualifications and the repair criteria(if repaired)of NLPA Standard <br /> 631,Section A10.4,Chapter A. <br /> 2) The entire interior of the tank was abrasive blasted to a white metal finish in accordance with <br /> NLPA 631, Chapter A, section A11.0 and that 90 PSI minimum air pressure was maintained at the <br /> blast nozzle and compressor during abrasive blasting. <br /> 3) The lining was holiday tested and free of holidays in accordance with NLPA 631,Chapter A, <br /> section A 13.1.3. <br /> 4) The barcol hardness of the lining met the lining manufacturers barcol hardness specifications <br /> and was performed in accordance with NLPA 631,Chapter A,section A13.1.2. <br /> 5) The final lining thickness was determined in accordance NLPA 631, Chapter A, section <br /> A13.1.1 and had a nominal thickness of 125 mils and a minimum thickness of no less than 100 <br /> mils. <br /> UNDER APPLICABLE FEDERAL LAW, IT IS THE RESPONSIBILITY OF THE OWNER OF <br /> THE UNDERGROUND STORAGE TANK TO DETERMINE THAT HIS TANK MEETS ALL <br /> REQUIREMENTS FOR VALID UPGRADE, THEREFORE THE TANK OWNER IS RELYING <br /> UPON THE UNDERSIGNED, TO PROPERLY AND FULLY PERFORM THIS INSPECTION <br /> AND WORK. AS NOTED IN NFPA 30, THE OWNER OR HIS DESIGNATED AGENT MAY <br /> BE THE AUTHORITY HAVING JURISDICTION. <br /> Sworn to and signed this day of ' 19— <br /> ;or 19_;or <br /> Special Inspector's Signature Qualified Person's Signature <br /> SWORN AFFIDAVIT* SWORN AFFIDAVIT <br /> NLPA Certification Number*Contractor(Employer) <br /> Expiration Date <br /> *Note: Special inspector and certification#is only to be signed <br /> and completed if the person has been certified as a special inspector by NLPA.If the person <br /> performing the work has not been certified by NLPA,the qualified person shall sign the above <br /> affidavit.The employer or contractor shall sign this form in all cases. NLPA inspector <br /> certification to perform internal inspections in accordance with NLPA 631 is valid for one year. <br /> Call or write to NLPA for verification of valid SPECIAL INSPECTOR certification number. <br /> 26 <br />