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General Inspection Information: <br />Inspection Date: _4VAO_.�* <br />Inspector Name (print <br />Inspector's Signature <br />Tank(s) inspected ID <br />STI SP001 Monthly Inspection Checklist <br />Prior Inspection Date: <br />until date: y 2 <br />Regulatory facility name and ID number (if applicable) �/zy L <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). Inspections of multi le <br />tanks may be captured on one form as long as the tanks are substantially the same. <br />➢ For equipment not included in this Standard, follow the manufacturer recommended inspection/testing schedules and procedures - <br />The D 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 />➢ Upon discovery of water in the primary tank, secondary containment area, interstice, or spill container, remove promptly or take other corrective action. Inspect the liquid <br />for regulated products or other contaminants and dispose of properly. <br />Non -conforming items im o t to tank or contain ent inte ri require evaluation b ane " q <br />manufacturer who will determine the corrective action. Note the non-conformance and corresponding experienced <br />action in the comment fisectlon.ector, or a tank <br />Retain the completed checklists for at least 36 months_ <br />After severe weather (snow, ice, wind storms) or maintenance (such as coating) that could affect the operation of critical components (normal and <br />emergency vents, valves), an Inspection of these components is required as soon as the equipment Is safely accessible after the event. <br />REM <br />_:::�STATUS COMMENTS /DATE cORRECTED <br />Tank and Piping <br />Is tank exterior (roof, shell, heads, bottom, connections, fittings, valves, etc.) free of visible <br />1 leaks? <br />Nate' ff "No , identify tank and describe leak and actions taken es ❑ No <br />2 Is the tank liquid level gauge legible and in good working condition? <br />❑ Yes ❑ No /q <br />3 Is the area around the tank (Concrete surfaces, ground, containment, etc.) free of visible <br />V. of leakage? <br />es ❑ No <br />Monthly Checklist <br />Page 1 of 3 <br />