J-1502000-10 UNDERGRD STORAGE TANK INSP FORM MONTHLY-ANNUAL.pdf
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- Solicitation number
- N40085-20-R-3006
About this file
This document contains an underground storage tank inspection form and details of a related federal contract opportunity. The inspection form is used to document the monthly and annual checks of underground storage tanks and associated equipment. It includes items like vent risers, spill buckets, monitoring devices, dispensers, cathodic protection systems, and spill response kits. Any defects must be repaired within 30 days.
The related federal contract opportunity is to provide testing, calibration, adjustment and repair services for aboveground and underground storage tanks, piping, piers and quay walls at the Naval Submarine Base New London in Groton, Connecticut. The contractor will be responsible for all labor, materials, equipment, transportation and management to perform this work, which includes cathodic protection, automatic tank gauging and fuel management systems. The solicitation was issued by the Naval Facilities Engineering Command Department of the Navy.
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UNDERGROUND STORAGE TANK INSPECTION FORM ‐ MONTHLY & ANNUAL
Tank ID #: Inspector’s Name (Print):
Tank Location: Date and Time:
YES NO N/A COMMENTS
1.0 TANK EQUIPMENT
1.1 Vent riser is corroding, deteriorating, damaged, or missing from primary tank and/or interstitial space.
1.2a Spill bucket missing or compromised?
1.2b Spill bucket contains fuel, water, or debris.
1.2c Spill bucket drain valve inoperable or open.
1.3 Oil, water or debris discovered in secondary piping containment/component sump of the UST system.
1.4 Evidence of a release in the transfer and dispensing areas not cleaned up or reported IAW applicable local, state and federal requirements.
2.0 MONITORING EQUIPMENT
2.1a No power to monitoring system(s).
2.2a Leak and product monitoring/detection devices/systems, alarm enunciation panels not operating properly.
2.2b Liquid level sensing devices are damaged.
2.3 Automatic tank gauge system does not test OK.
3.0 DISPENSER
3.1 Pressure/vacuum vent caps not functioning properly.
3.2 Each dry break poppet valve does not form continuous seal, or depress evenly across the valve seat, or reseat properly?
3.3a Motor fuel dispenser hoses have tears, leaks, holes, kinks, crimps or defects of any kind.
3.3b Motor fuel dispenser cabinet interiors show evidence of leakage in and around components and fittings.
3.3c Motor fuel dispenser cabinet sumps contain fuel, water, or debris.
4.0 CATHODIC PROTECTION (Impressed Current Only)
4.1a Impressed current system, including wiring and connections, is not functional.
4.1b Impressed current system components (i.e. ‐ switches, meters, alarms) are inoperable, damaged, or missing.
4.1c Rectifier Readings:
Hour Meter Ammeter Voltmeter
5.0 SPILL RESPONSE KITS
5.1 Spill kit is missing, needs restocking, or is not within a reasonable distance to tank, dispenser, or fuel transfer operation.
5.2 Spill kit container is in unsatisfactory condition (e.g., lid missing, holes/cracks, contains water).
6.0 OTHER CONDITIONS
6.1 Other conditions exist that should be addressed for continued safe operation or that may affect the site spill prevention plan.
7.0 ANNUAL INSPECTIONS ONLY (To be conducted in May of each year.)
7.1 Functionality test of the Automatic Line Leak Detector failed to operate as designed. (Pressurized piping system only)
Attach test results to this report.
7.2 Overfill prevention equipment (i.e., flapper valve, high level alarm) not functioning as designed.
Attach inspection results to this report.
7.3 Galvanic cathodic protection system (structure to soil test) voltage reading not within limits.
Attach inspection results to this report.
Per CTDEEP § 22a‐449 (d)‐108(c)(2)(C) ‐ “For any items for which a “defect” status has been recorded, repairs shall be performed not later than thirty days after discovery.” Describe action taken and provide the Work Request or Trouble Call tracking number: ___________________________
Corrective action(s) taken:
(Attach all repair documents and submit to NAVFAC PWD NLON EV Division.) Inspector’s Signature______________________________________
If kit is missing, do not replace.
File details come from the government source that posted it. Updated .