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i Inspection Date: Q1iy / ANNUAL INSPECTION CHECKLIST Facility Inspector: sv% i 14-e �t04 d r_ Inspector Title: (printed) D Complete this checklist on an annual basis.The periodic AST inspection is intended for monitoring the external AST condition and its contaimment structure.This visual inspection does not require a Certified Inspector.It should be performed by personnel who are familiar with the Facility and can identify changes and developing problems. a (*)designates an item in a non-conformance status and indicates action is required to address the problem.Note the location,nature of the non-conformance item,and conective action in the description. a Retain completed checklists for at least 36 months. » In order to comply with EPA SPCC rules,a Facility must regularly test liquid level sensing devices to ensure proper operation(40 CFR 112.8(c)(8)(v)). a Note:If a change has occurred to the tank system or containment that may affect the SPCC Plan,the condition should be evaluated against the current plan requirement by a Professional Engineer knowledgeable in SPCC development. Location/Inspection Item Circle One I..Description STORAGE TANKS The following items are operational: Vents N* Vc V;1 Valves (anti-siphon, check, gate, fire) N* V4 vz t (� Liquid level equipment Y I <W /1 u �+a v ,: +.ice✓ ' ZJ ' c ,� Overfill equipment y * " C., Tank surfaces show signs of leakage Y* Tanks are damaged Y* Bolts, rivets, or seams are damaged Y* Tank supports are deteriorated or buckled Y* Tank foundations have eroded or settled Y* Level gauges or alarms are inoperative Y* V eats are obstructed Y* Secondary containment is damaged or stained Y* Water/product in containment area Y* N Containment drainage valve is open or is not locked Y* N PIPING Valve seals, gaskets, or other appurtenances are leaking Y*