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0 0 <br /> INSPECTION AFFIDAVIT - FORM BF2 <br /> To: Owner of underground storage tank located at <br /> I, the undersigned, hereby swear an <br /> work was performed in accordance with Chapter B of NLPA 631 and hereby certify that the tank <br /> passed one of the following inspection criteria as indicated below: <br /> 1) The average tank metal thickness was greater than 85%of the original metal thickness and the <br /> addition of cathodic protection is not necessary. <br /> Flo <br /> 2) The average tank metal thickness was between 75%and 85%of the original metal thickness.A <br /> cathodic protection system shall be installed within 1 year from the date of this inspection. <br /> 3) The average tank metal thickness was found to be less than 75%of the original tank metal <br /> thickness and the tank did not meet the requirements of Chapter B of NLPA Standard 631. <br /> FAILED Inspectors Signature <br /> Note:If a cathodic protection system is installed in accordance with 40 CFR 280(b)(3)(ii),no future <br /> internal inspections are required. <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 OWNER IS RELYING UPON <br /> THE UNDERSIGNED, CERTIFIED SPECIAL INSPECTOR OR QUALIFIED PERSON TO <br /> PROPERLY AND FULLY PERFORM THIS INSPECTION. AS NOTED IN NFPA 30, THE <br /> OWNER OR HIS DESIGNATED AGENT MAY BE THE AUTHORITY HAVING <br /> JURISDICTION IN THOSE INSTANCES NOT OTHERWISE PROVIDED BY STATE OR <br /> LOCAL LAWS. <br /> Sworn to and signed this day of , 19 <br /> ;or <br /> Special Inspectors Signature Qualified Person's Signature <br /> SWORN AFFIDAVIT* SWORN AFFIDAVIT <br /> Contractor(Employer) <br /> Expiration Date <br /> The qualified person shall sign the above affidavit.The employer or contractor shall sign this form in <br /> all cases. <br /> Page 1 of 3 <br /> 51 <br />