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UNDERGROUND TANK INSPECTION RECORD � �M lL 7 <br /> NEW TANK INSTALLATION n <br /> SITE NAME INSPECTOR'S NAME ` 6"y O - <br /> ADDRESS _ / J (�/05PsCITY /V/y� /�/ <br /> �HkcG— ZIP <br /> CONTRACTOR: NAME _ ti�/'z e,i PHONE <br /> OWNER: NAME ('. yi-Or PHONE <br /> DIS INSPECTOR'S <br /> DATE kPPROVED NPPRUVED INITIALS <br /> ITEM OR EQUIPMENT INSPECTED <br /> r <br /> 1. Fees paid � <br /> V <br /> Approved J,, <br /> INITIAL INSPECTION <br /> UL numbers - 3 7yf b tank size 0 <br /> . Tank tested upon delivery [Holiday (ptasteet) or air at 5 PSI (FRP)1 <br /> L; <br /> �.4.) . Visual inspection of secondary containment. <br /> l � Tank appropriately placed with approved backfill. <br /> (PING STAGE INSPECTION <br /> 1. Pressure test of piping. [Primary and Secondary (NFPA 30)) <br /> d 2. Ball float valves installed. <br /> 3. Overfill protection installed, describe: <br /> 4. Unused tank opening sealed and cathodically protected. <br /> ✓ �+� 5. Visual inspection of secondary containment on piping. <br /> 6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br /> 7. Fill and vent piping brought to grade. <br /> d N B. Product line teak detector in place. (Hard wired) <br /> /all 9. Approved tank leak monitoring device installed. <br /> On l(q� J 10. All galvanized piping and fittings properly wrapped. <br /> N 1. Pressure decay test on complete tank and product delivery system. <br /> FINAL INSPECTION <br /> INS CA 1. Precision test successfully completed and hard copies received. (NFPA 329) <br /> r 2. Spill protection at fill pipe. <br /> M ✓ (P 3. Performance test of overfill protection system. <br /> ) 4. Performance test of product line teak detector. (Hard wired) <br /> - J 5. Performance test of continuous monitoring system(s) on tank (s) <br /> `6I/oLW 6. Permit to operate application complete. <br /> HI 7. Acceptable recordkeeping system. <br /> Comments: <br /> _ low <br /> EH 23 006 10/89 <br />