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0 0 <br />UNDERGROUND TANK INSPECTION RECORD <br />NEW TANK INSTALLATION <br />SITE NAME -VAe-r� INSPECTOR'S NAME <br />'-fADDRESS CITY _ /}'7�f , a rr._ zip <br />CONTRACTOR: NAME PHONE <br />ti— <br />OWNER. NAME �r1" / r r7 > 7 % f Ji.[� { PHONE c7 - �' 3 - — �( S <br />C, 7 (o <br />Comments: <br />FH 24 {roll 1n/no <br />DIS <br />INSPECTOR'S <br />INITIAL INSPECTION <br />1. UL numbers tank size <br />DATE <br />kPPROVED <br />PPROVED <br />INITIALS <br />2. Batt float valves installed. <br />ITEM OR EQUIPMENT INSPECTED <br />1. Fees paid <br />Plans Approved <br />5. Performance test of continuous monitoring system(s) on tank (s) <br />Comments: <br />FH 24 {roll 1n/no <br />INITIAL INSPECTION <br />1. UL numbers tank size <br />. Tank tested upon delivery [Holiday (plasteel) or air at 5 PSI (FRP)) <br />3. Visual inspection of secondary containment. <br />. Tank appropriately placed with approved backfill. <br />Comments: <br />FH 24 {roll 1n/no <br />[PING STAGE INSPECTION <br />1. Pressure test of piping. (Primary and Secondary (NFPA 30)1 <br />2. Batt float valves installed. <br />3. Overfill protection installed, describe: <br />4. Performance test of product line leak detector. (Bard wired) <br />4. Unused tank opening sealed and cathodically protected. <br />5. Performance test of continuous monitoring system(s) on tank (s) <br />5. Visual inspection of secondary containment on piping. <br />6, Permit to operate application complete. <br />6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />7. Acceptable recordkeeping system. <br />7. Fill and vent piping brought to grade. <br />S. Product line leak detector In piece. (Hard wired) <br />9. Approved tank leak monitoring device installed. <br />10. All galvanized piping and fittings property wrapped. <br />1. Pressure decay test on complete tank and product delivery system. <br />Comments: <br />FH 24 {roll 1n/no <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />2. split protection at fill pipe. <br />3. Performance test of overfill protection system. <br />4. Performance test of product line leak detector. (Bard 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 />FH 24 {roll 1n/no <br />