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' UNDERGROUND TANK INSPECTION RECORD <br />NEN TANK INSTALLATION <br />SITE NAME INSPECTOR'S NAME <br />`. ADDRESS (A). CITY <br />CONTRACTOR: NAME <br />OWNER: NAME <br />ve Nuznet <br />ZIP <br />PHONE <br />PHONE <br />DIS <br />INSPECTOR'S <br />esus¢ 4"4-. <br />'�' <br />DATE kPPROVED PPROVED <br />INITIALS <br />2. <br />2. Ball float valves installed. <br />ITEM OR EQUIPMENT INSPECTED <br />r <br />1. Fees paid <br />'71 <br />AIA <br />. Plans Approved <br />,ZjLllq( <br />4 <br />vaW rew -P-.,A <br />�° <br />esus¢ 4"4-. <br />'�' <br />PIPING STAGE INSPECTION <br />1. Pressure test of piping. (Primary and Secondary (NFPA 30)) <br />INITIAL INSPECTION <br />UL numbers gC���{'`) tank size �y.L. <br />2. <br />2. Ball float valves installed. <br />�t <br />r <br />3. Overfill protection installed, describe: <br />'71 <br />AIA <br />. Tank tested upon delivery [Holiday (plasteel) or air at 5 PSI (FRP)) <br />Visual inspection of secondary containment. <br />4. Unused tank opening seated and cathodically protected. <br />(jj <br />5. <br />Performance test of continuous monitoring system(s) on tank (s) <br />(ter% i✓ <br />U <br />Permit to operate application complete. <br />Tank <br />6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />°Z( <br />✓ <br />�•, <br />. appropriately placed with approved backfill. <br />,ZjLllq( <br />4 <br />vaW rew -P-.,A <br />�° <br />esus¢ 4"4-. <br />'�' <br />PIPING STAGE INSPECTION <br />1. Pressure test of piping. (Primary and Secondary (NFPA 30)) <br />Z <br />2. <br />2. Ball float valves installed. <br />�t <br />3. <br />3. Overfill protection installed, describe: <br />'71 <br />AIA <br />V <br />4. Unused tank opening seated and cathodically protected. <br />(jj <br />5. <br />Performance test of continuous monitoring system(s) on tank (s) <br />5. Visual inspection of secondary containment on piping. <br />U <br />Permit to operate application complete. <br />6. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />°Z( <br />✓ <br />7. Fill and vent piping brought to grade. <br />8. Product line leak detector in place. (Hard wired) <br />cN <br />9. Approved tank teak monitoring device installed. <br />10. All galvanized piping and fittings properly wrapped. <br />Z <br />1. Pressure decay test on complete tank and product delivery system. <br />i / <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />2. <br />Spill protection at fill pipe. <br />3. <br />Performance test of overfill protection system. <br />4. <br />Performance test of product line leak detector. (Hard wired) <br />5. <br />Performance test of continuous monitoring system(s) on tank (s) <br />6. <br />Permit to operate application complete. <br />7. <br />Acceptable recordkeeping system. <br />Comments: <br />EH 23 006 10189 <br />