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SPCC Petroleum Tank Visual Inspection REV Form 52136(07-27-2010) <br /> Location: Tank ID: <br /> Name & Middle Initial: Period Scheduled (Q/S/A): <br /> Inspector Phone No.: Date of Inspection: <br /> Overall Condition Rating of Components <br /> (1=Excellent Condition) (2=Good Condition) (3=Medium Condition Monitor) (4=Repair Within 30 days) (5=Failed Repair Now) <br /> Tank Foundation or Substructure <br /> Component Rate Comments or Recommendations <br /> Tank foundations are deteriorated or settled <br /> Tank Supports Cracking,Separated or Buckled <br /> Tank Superstructure <br /> Component Rate Comments or Recommendations <br /> Tank visible All sides/bottom for inspection: <br /> Yes No <br /> Condition of Paint <br /> Tank damaged,rusted or corrosion pitting <br /> Tank flanges showing leakage,fuel stain or weeping <br /> Tank wall deformation,bulging or bowing <br /> Tank welds,bolts,rivets or seams are damaged <br /> Tank level gauges or alarms are inoperative <br /> Overfill prevention equipment in good operating <br /> condition <br /> Tank roof deformation or vents are obstructed <br /> Ladders or Stairs damaged <br /> Decant Tank: Yes No Date: <br /> Spill and Overflow Containment System <br /> Component Rate Comments or Recommendations <br /> Dike Type: Earth Concrete <br /> Overall Condition of Dike(damaged,cracked,stained <br /> or excessive weed growth) <br /> Overall Condition of Floor(damaged,cracked or <br /> stained) <br /> Containment Area free of debris <br /> Dike drainage valve in closed position and locked <br /> If double-wall tank: <br /> • Interstice Space free of liquid <br /> • Interstice monitoring equipment in good <br /> operating condition <br /> Piping System Tank to Pump <br /> Component Rate Comments or Recommendations <br /> Piping(valve seals,gaskets or other parts not leaking) <br /> Condition of paint or corrosion if any <br /> Structural Pipe Supports damaged or deteriorated <br /> Piping(joints,valves,or other parts not leaking) <br /> Buried piping exposed or piping signage missing <br /> Page 1 of 2 <br />