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Form HA: Bulk Storage Container Annual Inspection Checklist <br /> REQUIRED INFO ,,TION: <br /> Inspection Date: //&7// Inspector Name: TEf?J!,�K Container Number: 875TFOO2 <br /> Location: 875 Hlbay Container Contents: Motor Oil <br /> Checklist--See Section HA for instructions and required follow-up actions for non-conforming items marked with an asterisk(*) <br /> Inspection Item: Status: If(*),is item important to Comments,Including <br /> tank or containment Follow-up Action taken <br /> integrity?(Y/N) (Work Order#,etc.) <br /> 1.0 Tank Secondary Containment Area <br /> 1.1 Is evidence of any of the following observed in the ❑Yes* <br /> containment structure:Holes or cracks in KNo <br /> containment wall or floor,liner degradation, ❑NA <br /> leakage <br /> 1.2 Are secondary containment drain valves operable ❑Yes <br /> and in a closed position? ❑No* <br /> XNA <br /> 2.0 Tank Foundation and Supports <br /> 2.1 Are visible signs of foundation settlement present? ❑Yes* <br /> VNo <br /> 2.2 Are visible signs of washout of containment, ❑Yes* <br /> foundation or supports present? KNo <br /> 2.3 Are visible signs of corrosion,paint failure,or ❑Yes* <br /> other defect present on the tank supports? 14 No <br /> ❑NA <br /> 2.4 Does water drain away from the tank? ❑Yes <br /> ❑No* <br /> .X NA <br /> 2.5 Is the concrete pad or ring wall cracking or ❑Yes* <br /> spalling? C No <br /> ❑NA <br /> 2.6 Is the tank grounding strap secured and in good ❑Yes <br /> condition? ❑No* <br /> XNA <br /> 3.0 Tank Exterior ❑Yes* <br /> 3.1 Is evidence of corrosion or coating failure KNo <br /> ------present? <br /> 3.2 Is evidence of any of the following observed in the I Yes* <br /> steel: Dents,Buckling,Bulging,Cracking 9No <br /> 4.0 Tank Equipment <br /> 4.1 Are tank vent components moving freely and are I(Yes <br /> vent passages unobstructed? ❑No* <br /> 4.2 Are visible signs of leaks,corrosion and/or damage ❑Ycs' <br /> present on any valves,gaskets,or piping? X No <br /> _....._...._..._.__...._........-..............------____._-------- <br /> _...___.._..._.._._.__..____.....__._..._--.----._...___-_--...__.._. <br /> 4.2.1 Cycle the anti-siphon check and gate valves_ ❑Ycs <br /> open and closed.Are they operating properly? ❑No* <br /> l�'NA <br /> 4.3 Check the condition of the interstitial leak <br /> detection equipment. <br /> a. Is the sight glass clean and clear for sight leak O Yes <br /> gauges? ❑No* <br /> XNA <br /> b. Are the wire connections of electronic gauges b Yes <br /> tight and free of corrosion? ❑No* <br /> DCNA <br /> C. If present,is the test button operational? d Yes <br /> ❑No* <br /> XNA <br />