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1 y • UNDERGROUND TANK INSPECTION RECORD <br /> NEW TANK INSTALLATION <br /> SITENAME _ �/ L �c �Cacvtl��'C <br /> INSPECTOR/'�S NAME <br /> ...ADDRESS �� L Soh CITY ti-j a. h <br /> / 21P <br /> CONTRACTOR: NAME _f7jm ��d/',/�P �.-� <br /> / PHONE <br /> OWNER: NAME _ / /< � Fu e% <br /> PHONE <br /> DIS INSPECTOR'S <br /> DATE PPROVED PPROVED INITIALS <br /> ITEM OR EQUIPMENT INSPECTED <br /> 1. Fees paid <br /> . Plans approved <br /> INITIAL INSPECTION <br /> 1. UL numbers tank size e) Q(J <br /> . Tank tested upon delivery (Holiday (pias reel) or air at 5 PSI (FRP)) <br /> Visual inspection of secondary containment. <br /> Tank appropriately placed with approved backfill. <br /> (PING STAGE INSPECTION <br /> VI � (,oc( 4Eq -k-s � �Pr� sM// <br /> 1. PfleaserT-test of piping. [Primary and Secondary � <br /> (N FPA 30)) <br /> v <br /> 2. Rall float valves installed. <br /> 3. Overfill protection installed, describe: <br /> 4. Unused tank opening sealed and cathodically protected. <br /> 5. Visual ins pecti of secorr4,ry containment on <br /> piping. <br /> v <br /> Monitoring ports in place and brought to gr d (lockab'e weather roof covers) <br /> �/ 7. Fill and vent piping brought to grade. <br /> B. 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 /> FINAL INSPECTION <br /> If�L 1. Precision test successfully completed and hard copies received. (NFPA 329) <br /> 2. Spill protection at fill pipe. <br /> 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 recordkeeping system. <br /> Comments: <br /> EH 23 006 10/89 <br />