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l w <br />UNDERGROUND TANK INSPECTION RECORD ee <br />NEN TANK INSTALLATION <br />SITE NAME 'POI L INSPECTOR'S NAME <br />.—ADDRESS 140 1�C}L109Y CWF3 BLVD. CITY �6'1"(�K 21P g52C�4 <br />CONTRACTOR: NAME _ �1Rt2f'T � 15C Gp kwaUC� ®IL� PHONE �4 �S�fX a -5511 <br />OWNER: NAME _. { . O t L PHONE <br />Zi l <br />DIS <br />INSPECTOR'S <br />INITIAL INSPECTION i <br />1. UL numbers _ tank size 1 I 0 09 <br />DATE <br />PPROVED <br />PPROVED <br />INITIALS <br />. Tank tested upon delivery tHoliday (ptasteet) or air at 5 PSI (FRP)) <br />I 0 <br />3. <br />Overfill protection Installed, describe: ► %1 SPU& <br />�'✓ <br />ITEM OR EQUIPMENT INSPECTED <br />r� \QV <br />v% <br />Unused tank opening seated and cathodically protected. p14 GUI U <br />1. Fees paid <br />2 �( <br />5. <br />Visual inspection of secondary containment on piping. <br />V <br />. Plans Approved <br />Zi l <br />(PING STAGE INSPECTION �� �1 fJ�Jt Z0% <br />1. Pressure test of piping. (Primary and Secondary (NFPA 30)) <br />INITIAL INSPECTION i <br />1. UL numbers _ tank size 1 I 0 09 <br />914'V-72. <br />Ball float valves installed. <br />. Tank tested upon delivery tHoliday (ptasteet) or air at 5 PSI (FRP)) <br />I 0 <br />3. <br />Overfill protection Installed, describe: ► %1 SPU& <br />�'✓ <br />Visual inspection of secondary containment. <br />r� \QV <br />v% <br />Unused tank opening seated and cathodically protected. p14 GUI U <br />Tank appropriately placed with approved backfill. <br />F <br />l /J,U <br />1*11 <br />(PING STAGE INSPECTION �� �1 fJ�Jt Z0% <br />1. Pressure test of piping. (Primary and Secondary (NFPA 30)) <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />914'V-72. <br />Ball float valves installed. <br />2. Spill protection at fill pipe. <br />8 <br />3. <br />Overfill protection Installed, describe: ► %1 SPU& <br />�'✓ <br />— --- <br />r� \QV <br />4. <br />Unused tank opening seated and cathodically protected. p14 GUI U <br />4. Performance test of product line leak detector. (Hard wired) <br />{( <br />5. <br />Visual inspection of secondary containment on piping. <br />V <br />5. Performance test of continuous monitoring system(s) on tank (s) <br />6. <br />Monitoring ports in place and brought to grade. (lockable weather proof <br />covers) <br />6. Permit to operate application complete. <br />7. <br />Fill and vent piping brought to grade. <br />`7 <br />7. Acceptable recordkeeping system. <br />" �! <br />8. <br />Product line leak detector in place. (Hard wired) <br />9. <br />Approved tank leak monitoring device installed.��(� <br />10. <br />All galvanized piping and fittings properly wrapped. <br />1 <br />Pressure decay test on complete tank and product delivery system. <br />l /J,U <br />1*11 <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NFPA 329) <br />qit <br />2. Spill protection at fill pipe. <br />�� <br />�'✓ <br />3. Performance test of overfill protection system. <br />r� \QV <br />4. Performance test of product line leak detector. (Hard wired) <br />{( <br />V <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 />EN 23 006 10/89 -- -- <br />