Potable_Water_inspection_sheet_Jan_19_2018.pdf

January 19, 2018 REGION 5 VIPR PRE-AWARD _____ Passed Inspection

POTABLE WATER TRUCK INSPECTION _____ Failed Inspection

Date: ____________ Time: _____

COMPANY/VENDOR NAME:_______________________________________________________________

(as shown in VIPR profile)

CONTACT NAME: ________________________________________________________________________

PHONE NUMBER: ______________________________ EMAIL: __________________________________

EQUIPMENT MAKE:__________________________________ MODEL: ___________________________

LICENSE PLATE: ___________________________________ STATE: ______________

VIN #: _________________________________________ EQUIPMENT/UNIT I.D. ____________________

OPERATOR NAME: _______________________________________ DRIVER’S LIC. # _____________________

EQUIPMENT and OPERATOR REQUIREMENTS POTABLE WATER TRUCK

Type 1: 4,000+ gallons Type 2: 2,500 → 3,999 gallons Type 3: 1,000 → 2,499 gallons Type 4: 400 → 999 gallons

1 VIN #: Vin# on Potable Water Truck matches VIPR Agreement. VIN # on Potable Water Truck matches

VIPR quote.

2 Vehicle Inspections: a) Annual USDOT certified vehicle inspection; or b) current Commercial Vehicle

Safety Alliance Inspection. (49 CFR 396.23).

Contractor shall provide a GVWR certificate from manufacturer: stating front, rear and total

GVWR at the pre-season. Only a written verifiable GVWR from the manufacturer or final stage manufacturer will be accepted. (D.2.1.2.5)

4 Tank Capacity meets the Typing Standards (D.2.1.1)

Potable Water Tank: Arrived empty for inspection. Tank made of non-toxic, non-corrodible/non-absorbent materials or coated with non-toxic coatings National Safety Foundation (NSF) International Standard

61 that can be adequately cleaned and sanitized. Ex. Stainless Steel, polyethylene, and food contact epoxy coatings. (D.2.1.2.1)

Sanitation: All equipment surfaces intended for potable water contact, including source fill point equipment, containers, caps, tanks, hoses, valves, and fittings shall be inspected, washed, rinsed, sanitized, and replaced as often as necessary to effect and maintain sanitation of such surfaces. (D.2.1.2.1)

7 Chlorine Residual Test Kits available: Contractors shall maintain a free chlorine residual level of 0.2 parts per million (ppm) up to 1.0 ppm at all times. (D.2.1.2.1)

Log book: Record of activities on board the vehicle showing water source location, dates, and times of loading, unloading, chlorine residual test results, cleaning/sanitizing, and other operational items as deemed necessary. Entries current and up to date (D.2.1.2.1)

9 Cleaning and Sanitizing: Written procedures for equipment cleaning and sanitizing shall be maintained by the Contractor and shall be kept with the hauling vehicle at all times. D.2.1.2.1)

10 Tank Certification: If required by the State or local health authority, a seal or sticker affixed to the tank shall be visible at all times indicating that the tank is in compliance with State or local health authority requirements. If inspection and certification of the tank is required by the State or local health authority but stickers are not provided, a copy of the certification shall be kept in the transport vehicle. (D.2.1.2.1)

Potable Water Tank: Both sides clearly labeled with “Potable” or “For Drinking Water Use Only”, Lettering is at least 4 inches in height and tank capacity displayed in Gallons, lettering at least 2 inches in height.

(D.2.1.2.1)

12 Name, City, and State of Contractor: On both sides of the tank or on both truck cab doors in lettering at least 2 inches in height. (D.2.1.2.1)

13 Openings: All hatches, inlets, outlets, and other openings are completely covered and sealed with tight fitting coverings, with permanently mounted food grade gaskets, and security locks. (D.2.1.2.1)

Minimum Requirements (continued) Yes No

14 Water inlets and outlets: Equipped with threaded or clamped caps, tethered to the ports with chain or cable. (D.2.1.2.1)

15 Tank Vents: Downward facing, or otherwise protected vent opening. Vent is protected by appropriate screened cover, (non-toxic, and non-absorbent). (D.2.1.2.1)

16 Tank Drain: A bottom drain to facilitate complete discharge of water during sanitation procedures.

(D.2.1.2.1)

Tank Filling Mechanism: An approved backflow prevention device complying with Uniform Plumbing

Codes 603.3.1, 2, 3, 4, 5 and 8 such as acceptable double check valves on the direct filling connection to the tank. No connections shall be located between the tank and the check valve. (D.2.1.2.1)

Overhead Filling: If overhead filling through a hatch opening at the top of the tank, the filling spout must not be allowed to intrude into the tank further than two diameters of the filling pipe above the highest water level that is possible when the tank is filled. When not being used for filling, this pipe shall be capped at each end with threaded or clamped caps, and tethered to the fittings at the ends of the filler pipe. (D.2.1.2.1)

Backflow: There shall be no backflow or cross connection between potable water systems and any other systems. Pipes and fittings conveying potable water to any fixture, apparatus, or equipment shall be installed in such a way to prevent backflow. Waste pipes from any part of the potable water system, including treatment devices, discharging to a drain, shall be suitably protected against backflow. (D.2.1.2.1)

20 Pump: Only those which can be readily disassembled to demonstrate the condition of the impeller and impeller chamber shall be used. The contractor shall have available at all times the manufactures product data information that demonstrates the materials in the pump housing are made of food grade material or the pump is suitable for domestic or potable water use. (if applicable) (D.2.1.2.1)

21 Approved spark arrester: On all naturally aspirated auxiliary engines (D.2.1.2.4)

Pumps, hoses, fittings, valves and similar equipment: Made of food-grade materials or materials meeting NSF International Standard 61 and shall be kept clean, disinfected and operated or handled in a manner that prevents contamination and capped or closed when not in use. Use of galvanized pipes or fittings is prohibited. (D.2.1.2.1)

23 Hoses: Shall have threaded or clamped caps. Caps shall be in place when hoses are not in use. Hoses in storage compartments must also be capped. (D.2.1.2.1)

24 Hoses: Hoses shall be marked/labeled at each end "potable water" (D.2.1.2.1)

25 Valved Outlets for filling canteens or other water containers: Minimum of seven evenly spaced, on a minimum 1 ½ pipe, with effective back flow prevention (check valves), and capped. Note: Threaded facets require vacuum breakers. (D.2.1.2.1)

26 Fire Extinguisher: 2A 10BC (with current annual maintenance tag) and securely mounted to the vehicle and accessible by the operator (D.2.1.2.4)

27 Seat Belt (D.2.1.2.4)

28 Flashlight (D.2.1.2.4)

29 Back-Up Alarm: (Audible reverse warning device) (D.2.1.2.4) Equipment meets agreement specifications Equipment does not meet agreement specifications

Inspector: Date:

(Print and sign)

Contractor: Date:

(Print and sign)

REMARKS:_______________________________________________________________________________