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Inspection Date: <br /> ANNUAL INSPECTION CHECKLIST <br /> Facility Inspector: Inspector Title: <br /> (printed) <br /> ➢ Complete this checklist on an annual basis.The periodic AST inspection is intended for monitoring the external AST condition and its containment structure.This visual inspection does not require a <br /> Certified Inspector.It should be performed by personnel who are familiar with the Facility and can identify changes and developing problems. <br /> ➢ (*)designates an item in a non-conformance status and indicates action is required to address the problem.Note the location,nature of the non-conformance item,and corrective action in the <br /> description. <br /> ➢ Retain completed checklists for at least 36 months. <br /> ➢ In order to comply with EPA SPCC rules,a Facility must regularly test liquid level sensing devices to ensure proper operation(40 CFR 112.8(c)(8)(v)). <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 requirement by a Professional <br /> Engineer knowledgeable in SPCC development. <br /> Location/Inspection Item Circle One Description <br /> STORAGE TANKS <br /> The following items are operational: - - <br /> Vents Y N* <br /> Valves (anti-siphon, check, gate, fire Y N* <br /> Liquid level equipment Y N* <br /> Overfill equipment Y N* <br /> Tank surfaces show signs of leakage Y* N <br /> Tanks are damaged Y* N <br /> Bolts, rivets, or seams are damaged Y* N <br /> Tank supports are deteriorated or buckled Y* N <br /> Tank foundations have eroded or settled Y* N <br /> Level gauges or alarms are inoperative Y* N <br /> Vents are obstructed Y* N <br /> Secondary containment is damaged or stained Y* N <br /> Water/product in containment area Y* N <br /> Containment drainage valve iso en or is not locked Y* N <br /> PIPING <br /> Valve seals, gaskets, or other appurtenances are leaking Y* N <br />