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STI SP001 Annual Inspection Checklist <br /> General Inspection Information: <br /> Inspection Date: Z I'Z Prior Inspection date: N�g �-L <br /> Retain until date: ut � <br /> Inspector Name(prints '171ff f�3 �uczL lVVI V0-0�t� <br /> Title:_ <br /> Inspectors Signature: wr1/�•�] e <br /> Tanks)inspected ID 16,b0-0 4doq �ia�f,►t �,r,�k1 <br /> Regulatory facility name and ID number(if applicable) <br /> Inspection Guidance: <br /> y This checklist is intended as a model. Locally developed checklists are acceptable as long as they are substantially equivalent(as applicable). <br /> Y For equipment not included in this Standard,follow the manufacturer recommended inspecdonitesting schedules and procedures. <br /> The periodic AST Inspection is intended for monitoring the external AST condition and its containment structure.This v€suaI 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 /> Remve 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 propedy. <br /> Y In order to comply with ERA SPCC(Spill Prevenlion.Control and Countermeasure)rules,a fariItty should reguIarty test liquid level sensing devices to ensure proper <br /> operation(40 CFR'it2.8(c)(8#)), <br /> > Non-eurdorming Items!mpgrtard 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 /> 1;, Retain the completed chec#dists 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 cendltion should be evaluated against t h a current plan <br /> requirement by a Professional Eeglnear knowtedgeable In SPCC development and Implementat[on. <br /> ITEM STATUS= <br /> COMMENTS/DATE CORRECTED <br /> Tank Foundation/Supports <br /> t Free of lank settlement or foundaticn washout{ Yes ❑(Ito <br /> Z Concrete pad or ring wall free of cracking and <br /> spauing? es ❑NO❑N/A <br /> Annual Checklist Page 1 of 4 <br />