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Attachment 5 OCT 2 3 2017 <br />1 TANK INSPECTION CHECKLIST <br />Page 3 of 4 ENVIRONMENTAL HEALTH <br />__,,r kt- <br />FACILITY NAME: <br />�P <br />LOCATION ON FACILITY: q <br />DATE OF INSPECTION: ID - b!% <br />Aboveground Tank <br />Petroleum level in tank <br />❑ Yes ❑ No ❑ NA <br />Appropriate appurtenances are properly configured <br />D Yes ❑ No D NA <br />Normal vent(s) and riser(s) present at proper elevation <br />and in good operating condition <br />1- Yes ❑ No '❑ NA <br />Emergency vent(s) present and in good operating <br />condition <br />❑ Yes ❑ No ❑ NA <br />Overfill protection present and in good operating <br />condition (e.g., spill container to catch any spills during <br />tank filling), and locked when not in use <br />D Yes ❑ No ❑ NA <br />? <br />Spill protection controls present and in good operating <br />condition (e.g., reservoirs, catchment basins for use <br />during tank filling and vehicle fueling) <br />D Yes ❑ No ❑ NA <br />- <br />Vapor recovery equipment present and in goad operating <br />condition <br />D Yes ❑ No [ NA <br />Tank hose nozzles secured and locked when not in use <br />❑ Yes ❑ No 1� NA <br />Corrosion protection controls present and in good <br />condition (e.g., paint, cathodic protection, etc.) <br />❑ Yes ,e3 No ❑ NA <br />Evidence of corrosion on tank, supports, piping, pumps, <br />valves, vents, etc. <br />31 Yes ❑ No D NA <br />Holes and/or cracks present in tank <br />❑ Yes No ❑ NA <br />Evidence of leakage from tank <br />D Yes No D NA <br />Evidence of leakage from valves, vents, fittings, piping <br />and other appurtenances <br />❑ Yes No D NA <br />Evidence of spillage on tank foundation <br />❑ Yes CIJ No ❑ NA <br />Secondary <br />Containment <br />Drain closed <br />1� Yes ❑ No ❑ NA <br />Free of debris (e.g., rainwater, snowmelt, dirt, leaves, <br />trash, stored materials, etc.) <br />Yes ❑ No D NA <br />Free of leakage (excluding rainwater or snowmelt) <br />4 Yes ❑ No ❑ NA <br />Visual leaks in containment drain <br />❑ Yes Na ❑ NA <br />Signs of cracks in containment walls <br />❑ Yes l No DNA <br />Signs -of cracks in. containment floor <br />❑ Yes No ❑ NA <br />Evidence of leakage or spillage <br />❑ Yes jNc ❑ NA. <br />BACC9 602.DBC-Z22-TRACY <br />