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. UNDERGROUND TANK INSPECTION RECORD <br /> J� NEW TANK INSTALLATION <br /> SITE NAME ( I �^o * .[., INSPECTOR'S NAME <br /> /.JL/ t om^ Rey C,, Q, <br /> 5 / � <br /> ADDRESS 4a�ro ��0 � e CITY /�, /Jtiit� 21P .7 Q <br /> CONTRACTOR: NAME F PHONE (r�Q p� L1� �� —2 QL--L_ <br /> OWNER: NAME PG) PHONE \ G� d 62-3— �a I/-- <br /> DIS INSPECTOR'S I <br /> DATE PPR�OVEEDD PPROVED INITIALS <br /> co I V C� r� ITEM OR EQUIPMENT INSPECTED <br /> / .I J`: 1. Fees paid <br /> �b�ai/Q� / Plans Approved <br /> / INITIAL INSPECTION <br /> 1. UL numbers .� D <br /> � �+ c — tank size Q <br /> l���/ ✓ � � Tank tested upon deliv� y (Holiday (plasteel r air at 5 PSI ( RP)) <br /> ((71� `� Visual inspection of secondary contairment. <br /> IC � 5 � � . Tank appropriately plated with approved backfill. <br /> (PING STAGE INSPECTION <br /> /Z a 1. Pressure test of piping. (Primary and Secondary (NFPA 30)) <br /> !' >/ 2. Ball float valves ins tatted. <br /> 3. Overfill protection installed, describe: <br /> 4. Unused tank openin Seale nd eethodically protected. <br /> 5. Visual inspection of secondary containment on piping. <br /> 6. Moni ing its i plecg end broug t to g ade. (tocka le weather pro f covers) <br /> 7. Fill and vent piping brought to grade. <br /> 'rj�. 8. Product line leak detector in place. (Hard wired) <br /> 4'4 Flz� 9. Approved tank leak monitoring device installed. <br /> 10. All galvanized piping and fittings properly wrapped. <br /> q-1 11. Pressure decay test on complete tank and product delivery system�C- <br /> / INAL INSPECTION <br /> �— O- v T� 1. Precision test successfully Completed and hard copies received. (NFPA 329) <br /> 2. Spill protection at fill pipe. <br /> �Jy ✓ n— 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 /> �(` d 7. Acceptable recordkeeping system. <br /> Comments- <br /> EH 23 006 yi�t�t <br /> / q' <br />