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Attachment 5 <br />TANK INSPECTION CHECKLIST <br />Page 1 of 4 <br />IECEIVED <br />. OCT 2 3 2017 <br />ENVIRONMENTAL HEALTH <br />r-krnn M-raAr-K1Z- <br />rAG1U FY NAME: El U ' <br />FACILITY LOCATION:p� T p�e� L L <br />DATE OF. INSPECTION: • <br />I VSPECT.ED BY: Qualified Tank Inspector (STI certified)? ❑ Yes ❑ No ❑ NA <br />Authorized Inspector (APE certified)? ❑ Yes ❑ No ❑ NA <br />NON -FACILITY INSPECTOR: ❑ Yes 0 No if yes, from: <br />INSPECTION TYPE? ❑ Daily X) 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 NA <br />1.1 Records of storm water discharge from secondary containment? ❑ Yes ❑ No 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? PI Tank rl r)rrrm r-1 r)tk— <br />2.1 <br />Age of tank? ��^ L/2cvv v�r',q S/Ze—_0 <br />2.2 <br />Type of tank? ❑ Rivetted Steel Welded Steel ❑ Other: <br />2.3 <br />Number of tank compartments? /p One (1) d Two (2)AV6AS <br />2.4 <br />Capacity of each tank compartment? ' Primary: b,A✓&A:� Secondary: q-j,;a® MV <br />2.5 <br />Content of tank compartments? Primary: <br />Secondary: A UDR <br />2.6 <br />is all associated piping aboveground? <br />❑ Yes <br />No ❑ NA <br />2.7 <br />Bottom of the tank visible for inspection? <br />({� Yes <br />❑. No <br />2.8 <br />How is small leak in tank bottom detected? <br />3.0 <br />Is there secondary containment? <br />El Yes <br />❑ No ❑ NA <br />3.1 <br />Type of secondary containment? ❑ Earth berm ❑ Concrete Curb ❑ Steel Pan <br />❑ Concrete Vault (ConVault) C9 Double wall ❑ Other: <br />Secondary containment area paved?❑Yes <br />No ❑ NA <br />13.2 <br />3.3 <br />Secondary containment drainage pipe'capped? <br />D Yes <br />❑ No ❑ NA <br />3.3 <br />Secondary containment drainage* valve(s)? <br />If yes, are the valve(s): Closed? ❑ Yes ❑ No • Locked? ❑ Yes <br />❑ Yes <br />❑ No <br />2!l No ❑ NA <br />3.4 <br />Secondary containment for the associated piping? <br />m Yes <br />❑ No ❑ NA <br />3.5 <br />Loading/pffloading areas paved and designed to contain spills? <br />13 Yes <br />C] No ❑ NA <br />3.6 <br />Interstitial monitor for leakage in double wall tank? <br />12(Yes <br />❑ No ❑ NA <br />BACC1602. DBC -Z22 -TRACY <br />