2 Attachment A Malmstrom AFB Annual UST.pdf

tankschedassessment.rpt

ANNUAL TANK ASSESSMENT CHECKLIST

341CES-500-1-UST-SF

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2000/01/01

12,000

Installation/GSU: Installation Date:

Owner: 465608Tank Real Prop ID:

Unit/Org: Supp Fac Real Prop ID:

Location: Designation: HFR - Underground

Model: Volume (Gallons):

Serial #:

MALMSTROM AFB

CC

0341 CIVIL ENGINEER SQ 0000

TANK 341CES-500-1-UST-SF

U-HFR-999000090568

07-08954 DIESEL FUELContents:

Finding Status:

Perform Date: Status:

Assessor: Duty Phone:

Comments:

Assessor Signature:

For Official Use Only

UST Annual Checklist review

1. Is the last annual checklist complete in STAR and found with no outstanding corrective action(s) or unaddressed findings?

Response: Yes No N/A

Comments:

2. Is the tank assessor/inspector conducting this inspection a qualified/trained operator?

Response: Yes No N/A

Comments:

UST Annual Venting

10. Is the normal vent extending upward at least 12 feet above grade?

Response: Yes No N/A

Comments:

UST Annual Normal Vent

12. Is the normal vent located five feet or more from adjacent buildings?

Response: Yes No N/A

Comments:

13. Is the normal vent clear and free of obstructions?

Response: Yes No N/A

Comments:

14. Is the normal vent cap in good condition?

Response: Yes No N/A

Comments:

15. Is the normal vent cap present, and the vent riser solidly supported and vertical?

Response: Yes No N/A

Comments:

UST Annual Pad

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UST Annual Pad (continued)

19. For tank pad and pavement: is concrete or asphalt over or near tank level with no significant cracks?

Response: Yes No N/A

Comments:

UST Annual Safety

20. Are there other conditions that should be addressed for continued safe operation or that may affect the site spill prevention plan?

Response: Yes No N/A

Comments:

21. Are fire extinguishers maintained in a serviceable condition and located in the designated area per NFPA 30 and 30A?

Response: Yes No N/A

Comments:

22. Are wiring conduit and probe electrical junction boxes in good condition?

Response: Yes No N/A

Comments:

UST Annual Spill Response

23. Are spill response kits properly supplied based on the product with absorbents, booms, PPE, etc. to properly contain/clean-up spillage from filling the tank?

Response: Yes No N/A

Comments:

UST Annual Auto Shutoff Valve

24. Does the automatic shutoff valve operate properly with passing inspection? Record date of last passing result.

Response: Yes No N/A

Comments:

UST Annual HLA

27. Verify the last passing result of the highlevel alarm? Record date of last passing results.

Response: Yes No N/A

Comments:

UST Annual Drop Tube

28. Is the drop tube smooth, with no ragged edges, and in good condition?

Response: Yes No N/A

341CES-500-1-UST-SF

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UST Annual Drop Tube (continued)

29. Does the drop tube extend to within six inches of the tank bottom (if no flow diffuser present)? Note: Inspection of the drop tube requires a qualified technician.

Response: Yes No N/A

Comments:

UST Annual Manhole

30. Are all manhole covers present, in good condition, seated firmly on the tank for the product type?

Response: Yes No N/A

Comments:

UST Annual Spill Prevention

31. Is spill prevention equipment (e.g., spill buckets) in good working condition and capable of containing spills?

Response: Yes No N/A

Comments:

32. Is spill prevention equipment free of corrosion?

Response: Yes No N/A

Comments:

UST Annual Fill Pipe

33. Is fill pipe free of obstructions (i.e. gauging stick segments, trash, debris etc.)?

Response: Yes No N/A

Comments:

34. Does the fill cap fit securely on the fill pipe, is in good condition and equipped with an intact gasket?

Response: Yes No N/A

Comments:

35. Does the fill cap assembly (i.e., brass coupler and swivel) function properly before, during and after deliveries without any damage?

Response: Yes No N/A

Comments:

36. Are the drain valves on the spill containment sump on the fill pipe operable and closed?

Response: Yes No N/A

Comments:

UST Annual Containment Sumps

37. Are containment sumps free of seepage, staining and pooling in the containment area and without indication of a release to the environment?

Response: Yes No N/A

Comments:

38. Are containment sumps (integrity) free of vegetation, holes, cracks, bulges, corrosion, fire hazards and damage?

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UST Annual Containment Sumps (continued)

39. Are containment sumps (or manholes) free of water, product and debris?

Response: Yes No N/A

Comments:

UST Annual Drainage

40. Does the water drainage system allow rainwater to drain away from the tank?

Response: Yes No N/A

Comments:

UST Annual Containment condition

41. Are the connections tight, including bolts, nuts, and washers on the riser pipe in the containment sump and/or manway?

Response: Yes No N/A

Comments:

42. Is there any corrosion, damage or wear that requires replacement on the riser pipe(s) in the containment sump?

Response: Yes No N/A

Comments:

UST Annual Interstice

43. In the interstitial space of DW tank, is there any evidence of foreign matter or liquid?

Response: Yes No N/A

Comments:

UST Annual Tank Release Detection

45. Have copies of passing release detection reports (i.e., leak detection test report) been obtained, for tank system, to meet record keeping and compliance requirements?

Response: Yes No N/A

Comments:

UST Annual ATG Electrical

47. Are there any exposed wires?

Response: Yes No N/A

Comments:

48. Are wire splices sealed, water-proof and in good condition?

Response: Yes No N/A

Comments:

49. If the probe electrical junction box has a cover, is it free of corrosion? Note: Inspection of the internal of the junction box requires a qualified technician.

Response: Yes No N/A

Comments:

50. Is the probe cap in good condition, seal tightly and is the penetration where the probe cap wire goes through sealed properly?

341CES-500-1-UST-SF

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UST Annual ATG

51. Is the ATG manhole cover in good condition?

Response: Yes No N/A

Comments:

52. Is there history of recurring alarms that present a systemic problem?

Response: Yes No N/A

Comments:

53. Is the release detection console operational with no active warnings or alarms?

Response: Yes No N/A

Comments:

54. Are tank release detection tests being completed with passing results?

Response: Yes No N/A

Comments:

UST Annual SIR

59. Do the statistical inventory reconciliation (SIR) results indicate passing for the previous 12 months?

Response: Yes No N/A

Comments:

UST Annual ATG Inspection

62. Is the annual electronic monitoring system (ATG and liquid sensors) inspection and testing complete with passing results? (Ref: 40

CFR 280.40)

Response: Yes No N/A

Comments:

UST Annual Manual Depth Measurement

63. Do hand-held release detection equipment (e.g., tank gauge sticks) accurately measure liquid depth?

Response: Yes No N/A

Comments:

UST Annual Reporting and Record Keeping

82. Is reporting being conducted to the appropriate agency and recordkeeping being maintained of required documentation? (40 CFR 280.34)

Response: Yes No N/A

Comments:

UST Annual Miscellaneous

83. Has an AF Form 332 been completed or electronic equivalent and submitted for any deficiencies observed? (Answer "no" if no deficiencies requiring a work request were noted)

Response: Yes No N/A

Comments:

84. If required, have all other Service, Local, State, or Federal requirements checklist(s) been accomplished, and documents uploaded/linked to this tank assessment record?

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MDEQ UST Annual Walkthrough Inspection

Visually check containment sumps for damage, leaks to the containment area, or releases to the environment.

Response: Yes No N/A

Comments:

Remove liquid and debris from containment sumps.

Response: Yes No N/A

Comments:

For double-walled sumps with interstitial monitoring, check for a leak in the insterstitial area.

Response: Yes No N/A

Comments:

Check hand-held release detection equipment such as tank gauge sticks for operability and serviceability.

Response: Yes No N/A

Comments:

Check that all annual (and triennial) tests have been performed within the last year (or three years) and are current, passing, and readily available for inspection.