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SITE NAME <br />CONTRACTOR: NAME <br />OWNER: NAME <br />UNDERGROUND TANK INSPECTION RECORD <br />NEW TANK INSTALLATION <br />CITY <br />INSPECTOR'S NAME <br />21P <br />PHONE <br />PHONE <br />tMell <br />9f <br />DIS <br />INSPECTOR'S <br />INITIAL INSPECTION <br />DATE <br />kPPROVED <br />PPROVED <br />INITIALS <br />t i <br />. UL numbers �C� i ('? tank size /0,000 0 <br />8 <br />f� <br />3. <br />Overfill protection installed, describe: <br />ITEM OR EQUIPMENT INSPECTED <br />4. Performance test of product line leak detector. (Hard wired) <br />/ <br />i� <br />✓ <br />1. Fees paid <br />f ee� <br />V <br />ll <br />Plans Approved <br />tMell <br />9f <br />(1p erstePIPING <br />�i <br />STAGE INSPECTION <br />1. Pressure test of piping. (Primary and Secondary (NFPA 30)) <br />INITIAL INSPECTION <br />V,- <br />t' <br />�'. <br />2. <br />Ball float valves installed. <br />t i <br />. UL numbers �C� i ('? tank size /0,000 0 <br />8 <br />f� <br />3. <br />Overfill protection installed, describe: <br />. Tank tested upon delivery [Holiday (plasteel) or air at 5 PSI (FRP)) <br />4. Performance test of product line leak detector. (Hard wired) <br />/ <br />i� <br />✓ <br />. Visual inspection of secondary containment. <br />Unused tank opening seated and catholically protected. <br />-4 (0 <br />6. Permit to operate application complete. <br />. Tank appropriately placed with approved backfill. <br />tMell <br />9f <br />(1p erstePIPING <br />�i <br />STAGE INSPECTION <br />1. Pressure test of piping. (Primary and Secondary (NFPA 30)) <br />Op1q, <br />V,- <br />t' <br />�'. <br />2. <br />Ball float valves installed. <br />f� <br />3. <br />Overfill protection installed, describe: <br />4. Performance test of product line leak detector. (Hard wired) <br />�1 <br />✓ <br />4. <br />Unused tank opening seated and catholically protected. <br />-4 (0 <br />6. Permit to operate application complete. <br />5. <br />Visual inspection of secondary containment on piping. <br />!Lek( <br />e0 <br />6. <br />Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />*j <br />7. <br />Fill and vent piping brought to grade. <br />11/ <br />8. <br />Product line leak detector in place. (Hard wired) <br />*01( <br />9. <br />Approved tank leak monitoring device installed. <br />10. <br />All galvanized piping and fittings properly wrapped. <br />2�1 <br />11. <br />Pressure decay test on complete tank and product delivery system. <br />07-gq( <br />/;E <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />Op1q, <br />V,- <br />2. Spill protection at fill pipe. <br />f. <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 />Zq! <br />6. Permit to operate application complete. <br />7. Acceptable recordkeeping system. <br />Comments: _ <br />5 23 006 10/89 <br />