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Annual Checklist Page 1 of 4 STI SP001 Annual Inspection Checklist General Inspection Information: Inspection Date: __________________ Prior Inspection Date: _________________ Retain until date: __________________ Inspector Name (print):________________________________________________________________ Title: _____________________________ Inspector’s Signature: ___________________________________________________________________________ Tank(s) inspected ID ___________________________________________________________________ Regulatory facility name and ID number (if applicable) ____________________________________________________________________ Inspection Guidance:  This checklist is intended as a model. Locally developed checklists are acceptable as long as they are substantially equivalent (as applicable).  For equipment not included in this Standard, follow the manufacturer recommended inspection/testing schedules and procedures.  The periodic AST Inspection is intended for monitoring the external AST condition and its containment structure. This visual inspection does not require a Certified Inspector. It shall be performed by an owner’s inspector per paragraph 4.1.2 of the standard.  Remove promptly standing water or liquid discovered in the primary tank, secondary containment area, interstice, or spill container. Before discharge to the environment, inspect the liquid for regulated products or other contaminants and disposed of it properly.  In order to comply with EPA SPCC (Spill Prevention, Control and Countermeasure) rules, a facility should regularly test liquid level sensing devices to ensure proper operation (40 CFR 112.8(c)(8)(v)).  Non-conforming items important to tank or containment integrity require evaluation by an engineer experienced in AST design, a Certified Inspector, or a tank manufacturer who will determine the corrective action. Note the non-conformance and corresponding corrective action in the comment section.  Retain the completed checklists for at least 36 months.  Complete this checklist on an annual basis, supplemental to the owner monthly-performed inspection checklists.  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 and implementation. ITEM STATUS COMMENTS / DATE CORRECTED Tank Foundation/Supports 1 Free of tank settlement or foundation washout? □Yes □No 2 Concrete pad or ring wall free of cracking and spalling? □Yes □No □N/A