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4 _ UNDERGROUND TANK INSPECTION RECORD <br />NEW TANK INSTALLATION <br />U <br />SITE NAME 41e/< a o •fb°Yt INSPECTOR'S NAME <br />O,_, -ADDRESS _ Cltwne CITY ��YeC k zip F&W001 <br />CONTRACTOR: NAME /rz. ' efr14 ,� <'r�/ �' a PHONE I'B' <br />OWNER: NAME =c l< � +Z>P PHONE -// S7— 6 ?7 -• 0 <br />J�/at97 <br />iz,ag?7 <br />kI <br />DIS <br />INSPECTOR'S <br />INITIAL INSPECTION <br />UL numbers tank size Li evaA. <br />DATE <br />kPPROVED <br />kPPROVED <br />INITIALS <br />Overfill protection installed, describe: <br />4. Performance test of product tine teak detector. (Hard wired) <br />t4 <br />ITEM OR EQUIPMENT INSPECTED <br />Unused tank opening sealed and cathodicatly protected. <br />1. Fees paid <br />/11'jr3 <br />5. <br />Visual inspection of secondary containment on piping. <br />Plans Approved <br />J�/at97 <br />iz,ag?7 <br />kI <br />1 5 <br />r1l1. <br />INITIAL INSPECTION <br />UL numbers tank size Li evaA. <br />2. Tank tested upon delivery [Holiday (plasteel) or air at 5 PSI (FRP)J <br />. Visual inspection of secondary containment. <br />. Tank appropriately placed with approved backfill. <br />2 <br />V710 <br />1 5 <br />i <br />(PING STAGE INSPECTION 1� 1 <br />1. Pressure test of piping. [ rimary and Secondary (NFPA 30)) <br />2. Balt float valves installed. <br />2. Spill protection at fill pipe. <br />3. <br />Overfill protection installed, describe: <br />4. Performance test of product tine teak detector. (Hard wired) <br />t4 <br />5. Performance test of continuous monitoring system(s) on tank (s) <br />6. Permit to operate application complete. <br />Unused tank opening sealed and cathodicatly protected. <br />5. <br />Visual inspection of secondary containment on piping. <br />6. <br />Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />(� <br />7. <br />Fill and vent piping brought to grade. <br />V, <br />8. <br />Product tine teak detector in place. (Hard wired) <br /><< <br />9. <br />Approved tank leak monitoring device installed. <br />(1 <br />10. <br />Alt galvanized piping and fittings properly wrapped. <br />q11. <br />Pressure decay test on complete tank and product delivery system. ' <br />ZS(�f ✓ <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />i <br />2. Spill protection at fill pipe. <br />3. Performance test of overfill protection system. <br />4. Performance test of product tine teak detector. (Hard wired) <br />L <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: r -CI&' <br />EN 23 006 10/89 <br />