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- IED <br /> AE <br /> � <br /> Attachment 5 OCT 2 3 2017 <br /> TANK INSPECTION CHECKLIST <br /> Page 1 of 4ENVIRONMENTAL HEALTH <br /> FACILITY NAME: ✓ <br /> FACILITY LOCATION: _ '� f - /3 )U <br /> DATE OF INSPECTION: <br /> INSPECT.® BY: Qualified Tank Inspector (STI certified)? ❑ Yes ❑ No ❑ NA <br /> Authorized Inspector (API certified)? ❑ Yes ❑ No ❑ NA <br /> NON-FACILITY INSPECTOR: ❑ Yes 2(No If yes,from: <br /> INSPECTION TYPE? ❑ Daily Weekly ❑ Monthly ❑ Quarterly ❑ Annual • ❑ Ten.(10) year <br /> Note: If Monthly, Quarterly, Annual or Ten (10)year, must do Tank Integrity Testing per Attachment 6 <br /> 1.0 Records of,petroleum discharge from secondary containment? ❑ Yes ❑ No El NA <br /> 1.1 Records of storm water discharge from secondary containment? ❑ Yes ❑ No )E NA <br /> 1:2 Records of leak sensor checks? ❑ Yes ❑ No ❑ NA <br /> 1.3 Records kept? Inspection: ❑ Yes ❑ No ❑ NA Discharge: ❑ Yes ❑ No ❑ NA <br /> 2.0 Type of petroleum container? eTank ❑ Drum ❑ Other Container: <br /> 2.1 Age of tank? /(V�j 6 -�K2�,; ✓ �Z <br /> 2.2 . Type of tank? ❑ Rivetted Steel l(Welded Steel ❑ Other: <br /> 2.3 Number of tank compartments? One (1) Two (2)-L—�iIAC <br /> 2.4 Capacity of each tank compartment? ' Primary: - ��' p econdary:��'� '�-VC-A5 <br /> 2.5 Content of tank compartments? Primary: ll s Secondary: �lVG�S <br /> 2.6 is all associated piping aboveground? ❑ Yes 7 No ❑ NA <br /> 2.7 Bottom of the tank visible for inspection? Yes ❑.No <br /> 2.8 How is small leak in tank bottom detected? <br /> 3.0 Is there secondary containment? Yes ❑ No ❑ NA <br /> 3.1 Type of secondary containment? ❑ Earth berm ❑ Concrete Curb ❑ Steel Pan <br /> ❑ Concrete Vault (ConVault) Double wall ❑ Other: <br /> 3.2 Secondary containment area paved? ❑ Yes 0 No ❑ NA <br /> 3.3 Secondary containment drainage pipe•capped? !a Yes ❑ No ❑ NA <br /> 3.3 Secondary containment drainage*valve(s)? ❑ Yes !'1 No ❑ NA <br /> If yes, are the valve(s).: Closed? ❑ Yes ❑ No •Locked? ❑ Yes ❑ No <br /> 13-4 Secondary containment for the associated piping? 4 Yes ❑ No ❑ NA <br /> 3.5 Loading/pffloading areas paved and designed to contain spills? ❑ Yes i7 No ❑ NA <br /> 3.6 Interstitial monitor for leakage in double wall tank? Yes ❑ No ❑ NA <br /> ��� BACC7 602.DBC-Z22-TRACY <br />