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STI SP001 Annual Inspection Checklist <br /> General Inspection Information: <br /> Inspection Date: 8"21 "19 Prior Inspection Date: Retain until date: C3R�IQ <br /> Inspector Name (print): 6COT ' t_I Chli n Title: 4,126 Senlee.✓! /y(taria per <br /> Inspector's Signature: �1 /1 <br /> Tank(s) inspected ID -Iank— 1ay'M —l'otmkS /, 2, 3,t <br /> Regulatory facility name and ID number(if applicable) <br /> Inspection Guidance: <br /> ➢ This checklist is intended as a model. Locally developed checklists are acceptable as long as they are substantially equivalent(as applicable). <br /> ➢ For equipment not included in this Standard,follow the manufacturer recommended inspection/testing schedules and procedures. <br /> ➢ The periodic AST Inspection is intended for monitoring the external AST condition and its containment structure.This visual inspection does not require a Certified <br /> Inspector. It shall be performed by an owner's inspector per paragraph 4.1.2 of the standard. <br /> ➢ Remove promptly standing water or liquid discovered in the primary tank,secondary containment area, interstice, or spill container. Before discharge to the <br /> environment, inspect the liquid for regulated products or other contaminants and disposed of it properly. <br /> ➢ In order to comply with EPA SPCC (Spill Prevention, Control and Countermeasure) rules, a facility should regularly test liquid level sensing devices to ensure proper <br /> operation (40 CFR 112.8(c)(8)(v)). <br /> ➢ Non-conforming items important to tank or containment integrity require evaluation by an engineer experienced in AST design, a Certified Inspector, or a tank <br /> manufacturer who will determine the corrective action. Note the non-conformance and corresponding corrective action in the comment section. <br /> ➢ Retain the completed checklists for at least 36 months. <br /> ➢ Complete this checklist on an annual basis, supplemental to the owner monthly-performed inspection checklists. <br /> ➢ Note:If a change has occurred to the tank system or containment that may affect the SPCC plan,the condition should be evaluated against the current plan <br /> requirement by a Professional Engineer knowledgeable in SPCC development and implementation. <br /> TEM',' STATUS`i COMMENTS/DATE CORRECTED <br /> Tank Foundation/Supports <br /> 1 Free of tank settlement orfoundation washout? 'ISYes ❑No <br /> 2 Concrete pad or ring wail free of cracking and <br /> 625 ❑NO ❑N/A <br /> spelling? <br /> Annual Checklist Page 1 of4 <br />