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Are all valves free of Peaks,corrasion and other <br /> damage's f=ollow rnanuFaCtWers`instructions For <br /> regular maintenance of these items. Check 11he <br /> following and verify(as applicable): <br /> a Anti-siphon valve fos ONO QWA <br /> 16 c Check valve C�Yas C]No Rt~ilA <br /> D Gate valva <br /> Pressure regulator valve QYes UNo 'ON/A <br /> r-3 Expansion relief valve Oyes ©No 9NIA <br /> a Solenoid valve E7Yes CINo RNIA <br /> o Fire value %fes MING ©NIA <br /> c Shear valve Mas Quo SRN(A <br /> 17 Are strainers and filters dean and in good condition? ❑Yes ❑No 9N/A <br /> Insufatod Tanks <br /> Free of missing insulation? LJ Yes LJ No PWA <br /> 7$ Insulation free of visible signs of damage? <br /> Insulation adequately protected from water Intrusion? <br /> 19 Insulation free of noticeable areas of mui5aure? ❑Yes ❑No l4N/A <br /> 20 Insulation free of mold? ❑Yes ❑ O X N/A <br /> 21 Free of visible signs of coating failure? ❑Yes ❑NO ON/A <br /> Tank I Piping Raloase Uatection <br /> 22 is inventory control being performed and docurttentod ,3Yes ❑No ❑N/A <br /> if required? <br /> 23 Is release detection being performed and documented XYes ❑No ❑N/A <br /> if required? <br /> Othor Equipment <br /> 24 Are electrical wiring and boxes ire good coadiUon? MYes ❑ISO ❑N/A <br /> Has the cathodic protection sysiem on ❑Yes ONO 5fN f A <br /> 25 the tank been tested as required by <br /> the designing engineer? <br /> Annual Checklist Page 3 of 4 <br />