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STI ",1001 Monthly Inspection Che,..Jist Inspection Dat _L_ ( �� Retain Until Date: __-�� f 5 W (36 months from inspection date) Prior Inspection Date: I , Inspector Name: -- R • N 6wo r -,c t7 Tanks Inspected (ID Ws): AST -1, AST -2 (Administration Building) Inspection Guidance: ➢ For equipment not included in this Standard, follow the manufacturer recommended inspection/testing schedules and procedures. r The periodic AST Inspection is intended for monitoring the external AST condition and its containment structure. This visual inspection does not require a Certified Inspector. It shall be performed by an owners inspector who is familiar with the site and can identify changes and developing problems. Upon discovery of water in the primary tank, secondary containment area, interstice, or spill container, remove promptly or take other corrective action. Before discharge to the environment, inspect the liquid for regulated products or other contaminants and disposed of it properly. ➢ (*) designates an item in a non-conformance status. This indicates that action is required to address a problem. r Non -conforming items important to tank or containment integrity require evaluation by an engineer experienced in AST design, a Certified Inspector, or a tank manufacturer who will determine the corrective action. Note the non-conformance and corresponding corrective action in the comment section. ➢ Retain the completed checklists for 36 months. ➢ In the event of severe weather (snow, ice, wind storms) or maintenance (such as painting) that could affect the operation of critical components (normal and emergency vents, valves), an inspection of these components is required as soon as the equipment is safely accessible after the event Item Task Status Comments 1.0 Tank Containment 1.1 Containment structure Check for water, debris, cracks or fire hazard 1-. es*f_4Vo -N/A 1.2 Primary tank Check for water 7Yes*A40 1.3 Containment drain valves Operable and in a closed position ?Yes No* N/A 1.4 Pathways and entry Clear and gates/doors operable >-4'es [-,,No* __,N/A 2.0 Leak Detection 2.1 Tank Visible signs of leakage :!yes*?GVo 2.2 Secondary Containment Visible signs of leakage from tank into secondary containment CYes*,'4-Vo N/A 2.3 Surrounding soil Visible signs of leakage Yes* CNo kN/A 2.4 Interstice Visible signs of leakage .1Yes**No —N/A 3.0 Tank Equipment 3.1 Valves a. Check for leaks. []Yes*54Vo . 1N/A b. Tank drain valves must be kept locked. Yes*-'No-;iQI/A 3.2 Spill containment boxes on fill pipe a. Inspect for debris, residue, and water in the box and remove. Yes*SNIo N/A b. Drain valves must be operable and closed. Yes*-,Na'<N/A 3.3 Liquid level equipment a. Both visual and mechanical devices must be inspected for physical damage. hYes No* N/A b. Check that the device is easily readable >ti'es _ No* N/A 3.4 Overfill equipment a. If equipped with a "test" button, activate the audible horn or light to confirm operation. This could be battery powered. Replace the battery if needed Yes )No*>qJ/A b. If overfill valve is equipped with a mechanical test mechanism, actuate the mechanism to confirm operation. -'Yes _,No*KN/A 3.5 Piping connections Check for leaks, corrosion and damage Yes*"o 4.0 Tank Attachments and Appurtenances 4.1 Ladder and platform structure Secure with no sign of severe corrosion or damage? ® Not Applicable 5.0 Other Conditions 5.1 Are there other conditions that should be addressed for continued safe operation or that may affect the site spill prevention plan? Yes* 4Q 0