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'I �+3 IY •, � •� k�fG <br /> STI SP-001 AST Monthly Inspection Checklist } <br /> _+ General Ins ection Information: <br /> Inspection Date: �L f3 o ZOZy Prior Inspection Date: �— ZZ <br /> Retain until date: ,. <br /> Inspector Name(print): �.P�f�C i� �(p —n. Q J» <br /> Title: ; <br /> Inspector's Signature <br /> Tank(s) inspected ID � ?j T t l7 w •'''., <br /> Regulatory facility name and ID number(if applicable) ) to L7 <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 multiple <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 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 /> L 1 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 /> `I ➢ 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 /> STATUS COMMENTS I DATE CORRECTED <br /> ITEM <br /> Tank and Piping <br /> YAC ES c��'F� <br /> Is tank exterior(roof,shell, heads,bottom,connections,fittings,valves,etc.)free of visible p Yes 'A No 7)' <br /> leaks? <br /> Note:If"No", identify tank and describe leak and actions taken. <br /> �Q,Yes ❑ No ❑ NIA <br /> 1 <br /> F2 Is the tank liquid level gauge legible and in good working condition? CaGq, TE �`��D <br /> Is the area around the tank(concrete surfaces,ground,containment,etc.)free of visible <br /> ❑Yes 'KNo <br /> 3 signs of leakage? <br /> Page 1 of 3 <br /> Monthly Checklist <br />