Attachment_D_Annual_Inspection_NotFitForService.pdf
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- Attached to
- HAFE-FUEL MANAGEMENT SYSTEMS SERVICE
- Solicitation number
- 140P2125Q0140
About this file
This document is an Annual Inspection Certification form for an Aboveground Storage Tank (AST) that has been determined to be "Not Fit for Service" under West Virginia Code of State Regulations (WV CSR) 47-63. The form is designed for a qualified individual, such as a Professional Engineer (P.E.), STI, or API certified inspector, to document and certify that an aboveground storage tank system does not meet minimum integrity standards. The certification requires the individual to document all deficiencies found during the inspection, provide recommendations for addressing these issues, and propose a schedule for removing the tank from service, making repairs, or permanently decommissioning the tank and its associated secondary containment system.
The form includes sections for detailed documentation, including the AST facility name, tank owner information, certifying individual's credentials, tank identification details, and DEP (Department of Environmental Protection) tank level classification. The document is dated V.7.22.2016 and is labeled as Attachment D, suggesting it is part of a larger regulatory compliance or inspection documentation process for managing aboveground storage tank systems in West Virginia.
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Text version
ANNUAL INSPECTION CERTIFICATION
Aboveground Storage Tank
Is Not Fit for Service
V.7.22.2016
☐ I am a qualified individual as described in WV CSR 47‐63‐5.2 and I have performed a tank evaluation on the above AST system. I certify the tank system does not meet the minimum integrity standards established by WV CSR 47‐63.
☐ I am the tank owner, operator, or qualified representative of the tank owner or operator and have performed a tank evaluation on the above AST System. I certify there is an obvious change(s) to the tank system that caused this tank to become Not‐Fit for Service, or that the tank remains not‐fit for service do to deficiencies that have not been abated, since it was certified by a PE, API or STI inspector on ____________ ______(date). This certification meets the requirements set in WV CSR 47‐63‐5.2.b.3 to certify annual inspections in intervening years between the evaluations required by a PE, API or STI inspector.
In accordance with the requirements of the WV CSR 47‐63, I have documented in writing, and attached hereto all deficiencies found during the inspection and provided my recommendations, including a proposed schedule for immediately taking measures to remove the tank from service and abating the deficiencies and requirements for repairs, replacement or permanent removal from service of the AST, AST system or secondary containment system, until the tank or secondary containment is made fit for continued service.
I certify that I have personally examined and/or am familiar with the inspection performed on the AST system listed above, including its associated equipment, leak detection system and secondary containment structure, if applicable, and that based on my direct knowledge that the AST listed above is Not‐Fit for Service.
Signature of Certifying Individual Date Signed
P.E. Registration #, STI Certification # or Registration/Certification Expiration Date API
Certification # (if applicable) (if applicable)
AST Facility Name
Address
City, State, Zip
Tank Owner Name
Telephone Number
Email Address
Certifying Individual
Address
City, State, Zip
Telephone Number
Email Address
Facility’s/Owner’s Tank ID
DEP Issued Tank Label
DEP Determined Tank Level Level 1 tank ☐ Level 2 tank ☐
Attachment D
| AST Facility Name: |
| Address: |
| City State Zip: |
| Tank Owner Name: |
| Telephone Number: |
| Email Address: |
| Certifying Individual: |
| Address_2: |
| City State Zip_2: |
| Telephone Number_2: |
| Email Address_2: |
| FacilitysOwners Tank ID: |
| DEP Issued Tank Label: |
| Date Signed: |
| PE Registration STI Certification or: |
| RegistrationCertification Expiration Date API: |
| Check Box1: Off |
| Check Box14: Off |
| Check Box15: Off |
| Check Box16: Off |
| Date5: |
File details come from the government source that posted it. Updated .