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Appendix F-2 STI SP001 Monthly Inspection Checklist General Inspection Info mat' n: Inspection Date: Prior Inspection Date: 'Y Retain until date: Inspector Name(print): Title: Inspector's Signatur Tank(s)inspected ID I V) a� �Czn ey�er4 y- Regulatory facility name and ID number(if applicable) (C Inspection Guidance: ➢ This checklist is intended as a model. Locally developed checklists are acceptable as long as they are substantially equivalent(as applicable). Inspections of multiple tanks may be captured on one form as long as the tanks are substantially the same. ➢ 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. Upon discovery of water in the primary tank,secondary containment area, interstice, or spill container, remove promptly or take other corrective action. Inspect the liquid for regulated products or other contaminants and dispose of properly. Non-conforming items important to tank or containment integrity require evaluation by an engineer experienced in AST design, a Certified Inspector,ora 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. ➢ After severe weather(snow,ice,wind storms)or maintenance (such as coating)that could affect the operation of critical components (normal and emergency vents,valves), an inspection of these components is required as soon as the equipment is safely accessible after the event. ITEM V '��__ _ ._�._ __ �_.____ _STATUSy_____ _ . �___..-COMMENTSTDATE"CORRECTED Tank and Piping Is tank exterior(roof,shell, heads, bottom,connections,fittings,valves, etc.)free of visible \ 1 leaks? @ Yes ❑ No Note:If"No", identify tank and describe leak and actions taken. 2 Is the tank liquid level gauge legible and in good working condition? Yes ❑ No ❑ N/A 3 Is the area around the tank(concrete surfaces,ground, containment,etc.)free of visible Yes ❑ No signs of leakage? Monthly Checklist Page 1 of 3