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SITE NAME 1►. <br />',—,ADDRESS <br />CONTRACTOR: NAME <br />N <br />UNDERGROUND TANK INSPECTION RECORD <br />NEN TANK INSTALLATION <br />OWNER: NAME ( ( <br />X t/ /®® �-- -I__ - Pd a i - <br />INSPECTOR'S NAME ___ AffffS CAN e� <br />CITY L ,� f ZIP 7,L //0 <br />PHONE <br />DIS INSPECTOR'S <br />INITIAL INSPECTION <br />. UL numbers tank size <br />DATE kPPROVED kPPROVED INITIALS <br />. Tank tested upon delivery (Holiday (plasteel) or air at 5 PSI (FRP)) <br />Performance test of overfill protection system. <br />ITEM OR EQUIPMENT INSPECTED <br />Li. <br />. Fees paid <br />4. Unused tank opening seated and cathodically protected. <br />. Plans Approved <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />INITIAL INSPECTION <br />. UL numbers tank size <br />Spill protection at fill pipe. <br />. Tank tested upon delivery (Holiday (plasteel) or air at 5 PSI (FRP)) <br />Performance test of overfill protection system. <br />. Visual inspection of secondary containment. <br />Li. <br />Tank appropriately placed with approved backfilt. <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />!PING STAGE INSPECTION <br />1. Pressure test of piping, (Primary and Secondary (NFPA 30)3 <br />Spill protection at fill pipe. <br />2. Ball float valves installed. <br />Performance test of overfill protection system. <br />3. Overfill protection installed, describe: <br />Performance test of product line leak detector. (Hard wired) <br />5. <br />4. Unused tank opening seated and cathodically protected. <br />6. <br />5. Visual inspection of secondary containment on piping. <br />Li7. <br />6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />7. Fitt and vent piping brought to grade. <br />8. Product line leak detector in place. (Hard wired) <br />9. Approved tank leak monitoring device installed. <br />0. All galvanized piping and fittings properly wrapped. <br />1. Pressure decay test on complete tank and product delivery system. <br />FINAL INSPECTION <br />1. Precision 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 />5. <br />Performance test of continuous monitoring system(s) on tank (s) <br />6. <br />Permit to operate application complete. <br />Li7. <br />Acceptable recordkeeping system. <br />Comments: <br />EN 23 006 10/89 <br />