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DECEIVED Attachment 5 OCT 2 3 2017 TANK INSPECTION CHECKLIST Page 3 of 4 ENVIRONMENTAL HEALTH rw,T FACILITY NAME: ; �� i � �i i` LOCATION ON FACILITY: & d DATE OF INSPECTION:��— - Aboveground Tank Petroleum' level in tank ❑ Yes ❑ No ❑ NA Appropriate appurtenances are properly configured ❑ Yes ❑ No ❑ NA Normal vent(s) and riser(s) present at proper elevation and in good operating condition Yes ❑ No '❑ NA Emergency vent(s) present and in good operating condition ❑ Yes ❑ No ❑ NA Overfill protection present and in good operating condition (e.g., spill container to catch any spills during tank filling), and locked when not in use ❑ Yes ❑ No ❑ NA Spill protection controls present and in good operating condition (e.g., reservoirs, catchment basins for use during tank filling and vehicle fueling) ❑ Yes ❑ No ❑ NA Vapor recovery equipment present and in good operating condition ❑ Yes ❑ No 6 NA Tank hose nozzles secured and locked when not in use ❑ Yes ❑ No ZINA Corrosion protection controls present and in good condition (e.g., paint, cathodic protection, etc.) ❑ Yes 8 No ❑ NA Evidence of corrosion on tank, supports, piping, pumps, valves, vents, etc. Z Yes ❑ No ❑ NA Holes and/or cracks present in tank ❑ Yes )Z No ❑ NA Evidence of leakage from tank ❑ Yes 2 No ❑ NA Evidence of leakage from valves, vents, fittings, piping and other appurtenances ❑ Yes .A No ❑ NA Evidence of spillage on tank foundation ❑ Yes Z No ❑ NA Secondary Containment Drain closed ,P! Yes ❑ No ❑ NA Free of debris (e.g., rainwater, snowmalt, dirt, leaves, trash, stored materials, etc.) 4 Yes ❑ No ❑ NA Free of leakage (excluding rainwater or snowmelt) - Z Yes ❑ No • ❑ NA Visual leaks in containment drain ❑ Yes Z No ❑ NA Signs of cracks in containment walls ❑ Yes No ❑ NA Signs,of cracks in, containment floor ❑ Yes eI No ❑ NA Evidence of leakage or spillage ❑ Yes O -No ❑ NA. BACCZ 602.DBC-Z22-TRACY