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I :JNDERGRCUND TANK INSPECTION RECORD <br /> NEW TANK INSTALLATION / ,O <br /> INSPECTOR'S NAME I.tJLI � cc, ' "` CI <br /> AM <br /> CITY J-I� � n4ianon� _�(ryIIP 9z iC O,-.� <br /> H F1 VI/1 /' O PHONE O (oV a J � 7 7 <br /> NAME r �1' � 1..� <br /> (' t / PHONE �1 <br /> ,wNER: NAME l� <br /> DIS INSPECTOR'S <br /> DATE / PP,ROV/ED PPROVED INITIALS ITEM OR EQUIPMENT INSPECTED <br /> 9)f1��t 1. Fees paid <br /> • Plans Approved <br /> INITIAL INSPECTION 77�� Q1ES�1 <br /> UL numbers a 37195 tank size Ll <br /> Tank tested upon deliv y [Holiday (plastee() or air at 5 PSI P)7 <br /> Visual inspection of secondary containment. <br /> Tank appropriately placed with approved backfill. <br /> IPING STAGE INSPECTION JO rt'Sr <br /> %� 7... I � 1. Pressure test of piping. (Primary andecondary NFPA 30)l <br /> z <br /> 2. Ball float valves installed. <br /> 3. Overfill protection installed, describe: <br /> 4. Unused tank openin sealed nd cathcdically protected. <br /> v 1 5. Visual inspection of secondary containment on piping. <br /> (_ _�Y ✓ 6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br /> 7. Fitt and vent piping brought to grade. <br /> D. Product line leak detector in place. (Hard wired) <br /> 9. Approved tank leak monitoring device installed. <br /> 10. All galvanized piping and fittings properly wrapped. <br /> 11. Pressure decay test on complete tank and product delivery system. / <br /> i <br /> INAL INSPECTION <br /> 1. Precision test successfully completed and hard copies rec=(NFPA <br /> 2. Spill protection at fill pipe. <br /> 1 _4a 3. Performance test of overfill protection system. <br /> 1 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 /> �e �] 7. Acceptable recordkeeping system. <br /> . <br /> Comments: :F r�Ti( wake <br /> EN Z3 006 10/89 <br />