HomeMy WebLinkAboutInspectionsKERN COUNTY HEALTH DEPARTMENT
ENWIRON~ENTAL HEALTH f~SION
HAZARDOUS SUBSTANCES SEL'TION
;" · INSPECTION RECORD
· ' 'J ~' ~''' ~' POST· CARD AT JOBSITE
1700 FLOWER STREET
BAKERSFIELD, CA 93305
PHONE (805) 861-3636
ADDRESS H~ ~A ~ ~', ' ADDRESS I~l 5~;~
P.ONE NO. I ~O~- ~I-
INSTRUCTIONS: Please call for an {Inspector only when each group of inspections
with the same number' are ready. They will uun in consecutive order beginning
with number 1. .DO NOT cover work fo~ any numbered g~oup until all items
that group are signed =.off by .the Perm2tt~ng Authority. Following these
lnstrutions will 'reduce. the number of ~equired inspection visits and therefore
.prevent assessment of additional fees.
- TANKS & BACKFILL -
INSPECTION DATE INSPECTOR
{'Backfill of Tank(s)
I Spark Test Certification
Cathodic Protection of Tank(s)
'- PIPING SYSTEM -
~Piping ~-~ w/Collection Sump
~.Corrosion Protection of Piping, Joints, Fill P~pe/o-Z~8K
Electrical Isolation of Piping From Tank(s)
Cathodic Protection System-Piping
- SECONDARY CONTAINMENT, OVERFILL PROTECTION. LEAK DETECTION -
Liner Installation - Tank(s)
~Liner Installation - Piping /~-~-~ Z~~d~.'
Vault With Product Compatible Sealer ~ .
~Level Gauges or sensors, Floa~ V~pt-Valve~
~!Product Compatible Fill Box(es) '~-/~.-~"~
Product Line Leak Detector(s)
Leak Detector(s) for Annular Space-D.W. Tank(s)
~MonitocinK Well(s)/Sump(s)
Leak Detection Device(s) For Vadose/Oroundwater
- FINAL -
~)~onitoring Wells, Caps & Locks ~'-/~-~
Fill Box Lock
Monitoring Requi~em,ents
.......
/,
LICENSE · 4:d-77¢7
PU # ' _..~7" ~-~4-/
,,
Facility:
Jlpment to be installed:
Tank(s)7~ Ft. of
~ Approved
Standard Compliance Ch
~"-]Suctlon
CT
J~Pressurtzed [-]Gravity,
Proof of Contractor's License - License
Type of License
Proof of Contractor's~ #orker's Compensation Insurance
Primary Containment
Fiberglass (FRP)
Fiberglass-clad steel
Uncoated steel
[-]Other:
Comment:
Piping
Nake& Model
Make & Node
Nake& Nodel
Nake& Nodel
Additional:
Inspection:
Secondary Contalnnent of Tank(s) /~
~Double-walled task(s) Nake& Nodel,,,,.5~/ ~o~.
~]Synthetlc liner Nake& Nodel
Ltned concrete vault(s) Sealer used
Other Type .Nake& Nodel
Comment:
Additional:'
Inspection:
Secondary Containment Volume at Least IOOX of Primary Tank
Additional:
Inspection:
Secondary Containment Volume for More Than One Tank
Contains 150~ of 'Volume of Largest Primary Containment or
10~ of Aggregate Primary Volume, #hlchever is 6reater
Comment:
Additional
Inspection:
" 1
Extra Inspecttons/Retnspectlons/Consultations
Comment:
.: .Tile Utilized .
COllent:
Tile Utilized
Purpose:
COllent:
Time Utilized
Date:
COllent:
Tl.e Utilized
Invoice Date:
Total Time:
Inspector Date:
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