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ANDERGROUND TANK INSPECTION RECORD <br /> {'� NEW TANK INSTALLATION / - ,,/ <br /> SITE NAME I",1 , �, ^^ INSPECTOR'S NAME /�a4i�a, ,� <br /> ADDRESS ( D (fD AI_/2 �"�" ��t �y1fL� CITY -S+IO C .[� / (, ZIP 9. <br /> CONTRACTOR: NAME I � k. r Y l L O PHONE �qq l — 2277 <br /> _ <br /> OWNER: NAME PHONE p� a <br /> f <br /> DIS INSPECTOR'S <br /> DATE PPROVED PPROVED INITIALS <br /> 9I <br /> lII 1( -"" -rMl� 1. Fees paid ITEM OR EQUIPMENT INSPECTED <br /> Q� 1�'T <br /> I(� aI (1 l 0�- Plans Approved <br /> INITIAL INSPECTION 9� D1�•S�-� <br /> UL numbers Q 3 7 / %T tank size V <br /> . Tank tested upon deliv y [Holiday (plasteel) or air at 5 PSI P)) <br /> v <br /> . Visual inspection of secondary containment. <br /> Tank appropriately placed with approved backfill. <br /> 1 <br /> (PING STAGE INSPECTION .Sb teS7- <br /> 1. Pressure test of piping. (Primary and SiiED>NFPA 30)) <br /> Z. Ball float valves installed. <br /> - / <br /> �l�v 3. Overfill protection installed, describe: <br /> - <br /> a 14-204. Unused tank opening eaI ed)§nd cathodically protected. <br /> - L t �. 5. Visual inspection of secondary containment on piping. <br /> (p"q 6. Monitoring rt In p e and brought o gra e. (lockab weather pr f covers) <br /> 4'9 ✓ 7. Fill 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 /> 10. All galvanized piping and fittings properly wrapped. <br /> 11. Pressure decay test on complete tank and product delivery system. <br /> rt <br /> INAL INSPECTION <br /> 1. Precision test successfully completed and hard copies received. (NFPA 329) <br /> 2. Spill protection at fill pipe. <br /> ♦, 1p'h� '�, 3. Performance test of overfill protection system. <br /> 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 /> �� `( ✓ 7. Acceptable <br /> /reco�rdkeeping system. <br /> . <br /> Comments: <br /> EH 2 � <br />