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❑� .0 C1EP4gT��Z <br /> p z Stationary Poly Tank Inspection Form <br /> I spoil <br /> DATE LOCATION OF TANK ASSET NUMBER <br /> LU SEVERITY <br /> LU <br /> J <br /> Z Z <br /> IL LU LUQ <br /> o� ITEM Q ITEM <br /> U <br /> O } 11f W O <br /> QQ O <br /> Y W O W Y Z OLU <br /> O z cn O 5 02 FnWW <br /> EQUIPMENT REVIEW TANK REVIEW <br /> Are pipes cracked or broken? Is the tank damaged (e.g. dented, discolored, or <br /> flaking)? <br /> Is there damage to pipes from vibration, Is there bending or swelling of the tank wall that is <br /> expansion, settlement, or impact? different from normal expansion? <br /> Are there leaks or drips (unusual <br /> moisture)along the pipe runs? Does the tank wall feel spongy? <br /> Is the tank lid broken or missing? Are cracks visible without using a detailed <br /> inspection test(listed below)? <br /> Are fittings or flanges pulling away from DETAILED INSPECTION of POLY TANK <br /> the tank? <br /> Are the tanks, pipes, and fittings Complete one or both tests if any response other than "okay" <br /> adequately supported and secured? is checked on a tank review question <br /> Are valves or gaskets misaligned, loose, BLACK MARKER TEST—for a specific area <br /> brittle, or deteriorated? Are stress cracks visible in the tested area? <br /> Are pumps and other equipment LIGHT TEST—for the whole tank <br /> adequate for the workload? Are stress cracks visible? <br /> Are plumbing fittings or hoses loose, Complete test if stress cracks are observed. <br /> broken, or worn? Recheck for stress cracks after baseball bat test. <br /> Do pumps or other equipment need BAT TEST—for affected areas <br /> servicing or replacement? Did the impact affect the tank? <br /> COMMENTS: <br /> INSPECTION FREQUENCY IS BASED ON THE SEVERITY OF VISIBLE DETERIORATION NEXT INSPECTION DUE BY: <br /> OKAY=ANNUAL;MINOR OR MODERATE=6 MONTHS;SIGNIFICANT=OUT OF SERVICE <br /> INSPECTED BY: REVIEWED BY: <br /> CREW SUPERVISOR: <br /> Stationary Poly Tank Inspection Form—Version 2—December 21, 2012 Page 1 of 1 <br />