Attachment_3_Operators_Annual_Inspection_Short_Form.pdf
PDF 113 KB Posted
- Attached to
- Underground Tank Inspection and Testing Services Federal contract opportunity
- Solicitation number
- 140P1424Q0058
About this file
This document is an Operator's Annual Inspection form for the Wyoming Storage Tank Program. The form is used by facility operators to document the annual inspection of underground storage tanks, including testing of line leak detectors, interstitial monitoring systems, corrosion protection, and other miscellaneous equipment. Key details include:
The form requires the operator to provide information about the facility, such as the facility number, name, owner, address, and contact information. It also requires the name, license number, and company of the tester. The operator must indicate whether various systems and components were tested and functioning properly during the inspection, such as line leak detectors, interstitial monitoring, corrosion protection, spill buckets, under dispenser containment, and other equipment. The operator must sign the form and submit it along with 12 months of tank leak detection records to the Wyoming Department of Environmental Quality Storage Tank Program.
View the file
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Text version
Wyoming Storage Tank Program Operator’s Annual Inspection
DATE: WYOMING FACILITY NUMBER:
FACILITY NAME: OWNER NAME:
Address: Mailing Address:
City: City, State, Zip:
Phone: Phone:
Tester: Tester License Number:
Tester Company Name: Operator Signature & License #:
NOTE: WHEN THE OWNER/OPERATOR SUBMITS COPIES OF THIS OPERATORS ANNUAL INSPECTION FORM TO THE DEQ STORAGE TANK PROGRAM, THEY ARE ALSO REQUIRED TO SUBMIT COPIES OF THE TANK LEAK DETECTION RECORDS FOR THE PRECEDING 12 MONTHS.
LINE AND LINE LEAK DETECTOR TESTING
Type of line leak detectors installed: MLLD, ELLD, Sump Sensors, Etc.
Were line leak detectors/sump sensors function tested during the inspection ?
(if yes, attach testing documentation)
Yes / No N/A
Did all line leak detectors including any sump sensors, function properly when tested at the time of the inspection?
Were lines tightness tested (if yes, attach testing documentation) Yes / No N/A
TANK LEAK DETECTION
Were Automatic Tank Gauging (ATG) systems properly calibrated and operating properly at the time of the inspection? Verify system configuration and test ATG backup battery for proper operation.*
Yes / No N/A
Were Interstitial Monitoring (IM) systems properly tested and Interstitial Probes functioning properly at the time of the inspection.
Yes / No N/A
Did any alarm conditions or warnings exist at the time of the inspection including Interstitial Indicators?
Are ATG or Interstitial Probes clean and correct for substance stored. Were all records reviewed and current?
CORROSION PROTECTION (CP)
Was the Corrosion Protection system tested during the inspection? (If so, include testing documentation) CP Test Date: _________________________
MISCELLANEOUS EQUIPMENT
Were all openings to the tanks inspected, drop tube fill caps securely in place, working properly, Over fill device tested per RP-1200 procedures, and turbine sumps integrity tested per RP-1200 procedures?**
Were spill buckets clean and free of debris, water, and fuel or product ?
Was Integrity testing performed per RP-1200 procedures?**
Were dispensers inspected, Fire/Safety/Shear Valves Anchored, and any test equipment removed. Were Under Dispenser Containment (UDC’s) Integrity
Tested per RP-1200 procedures? **
Yes / No N/A
Note: New EPA rules require the following to be completed by October of 2018
* Annually check the operation of the ATG battery
** An integrity test of spill buckets, all turbine sumps, and under dispenser containment sumps that utilize sump sensors every three years per RP1200.
(All tanks and lines installed after 12/1/2005 must be interstitially monitored)
Notes:
| DATE: |
| WYOMING FACILITY NUMBER: |
| FACILITY NAME: |
| OWNER NAME: |
| Address: |
| Mailing Address: |
| City: |
| City State Zip: |
| Phone: |
| Phone_2: |
| Tester: |
| Tester License Number: |
| Tester Company Name: |
| Operator Signature License: |
| Type of line leak detectors installed MLLD ELLD Sump Sensors Etc: |
| Was the Corrosion Protection system tested during the inspection If so: |
| Notes: |
File details come from the government source that posted it. Updated .