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0 <br />Monthly Storage Tank, Container and Storage Area Inspection Form <br />Inspector Name: <br />Inspection Date: <br />Complete the following table for each tank system. For each tank system, indicate if an inspection was completed (Y or N). <br />Indicate any comments or deficiencies in the space provided below the table. This inspection form most be maintained at the <br />facility for a minimum of three years. <br />Inspection Item <br />I3,t1a01'dia� <br />Wesal iad <br />ant 1 - hr►t Oat <br />Saa•Gsite� <br />Uaar on <br />Hadar 9ntNe <br />I,MlaCallaa <br />Utad oU <br />aeY a • tldaireaan <br />laaGaUsa <br />It7droulic Ott <br />ask! • AIelnlesane <br />Tan lt/Contalner Conditlon <br />Lcaks <br />Corrosioni Diacolomtion <br />CrackslBul <br />es7Pittin <br />Paint Condition <br />Tank Labcls$Warnin Si <br />Gau a Functionin <br />Overfill Protection Workin <br />Foundation/structural <br />SetdementlCmcks <br />Separation <br />Secondary Containment System <br />Cracks, gaps, punctures, <br />,MEstations, corrosion <br />Excessive Veizetation <br />Paint/Sealant Condition <br />iiwEiii-5- <br />Storm Water Accumuiation <br />Is Water discolored�sheen <br />Is there debris in arca <br />Pipts/Valvts(Pumps/Entergency Response Equipment <br />Fill Ports Color i <br />Paint (Condltion <br />Drainaae Valves <br />Kits in Place <br />CommenWDeficiencies (Inspector must inform SPCC coordinator of any deficiencies): <br />THE SIGNATURES BELOW CERTIFY THAT THE INSPECTION WAS PERFORMED IN A MANNER CONSISTENT <br />WITH THE REQUIREMENTS OF 40 CFR Part 112. <br />Signature of Inspector: Date: <br />l <br />• N <br />