SFLC-ESD-25_Tank_and_Void_Assessment_Form.pdf

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USCGC Joseph Gerczak Dockside Tank Clean & Inspect
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70Z03426QHONO1000
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This is a Tank and Void Assessment Form (SFLC-ESD-25) used for inspecting and documenting the condition of ship tanks and void spaces. The form is designed to be completed by an inspector and captures comprehensive data across multiple assessment categories. The General Data section requires documentation of the inspector's name, organization, cutter name and class, hull identifier, tank service type, tank area, and capacity in gallons, along with the date and reason for assessment.

The form systematically evaluates tank condition through eight primary data categories: Access Data (manhole and tank penetration condition), Vent Overflow Data (presence and functionality of check valves), Ladder Data (presence, damage, and material type), Tank Level Indicator Data (presence and damage), Sounding Tube Data (presence, damage, and striker plate condition), and Cathodic Protection Data (zinc presence and depletion levels). The assessment includes structured rating scales for Cleanliness & Housekeeping, Coating Systems, and Structural conditions (corrosion, pitting, and grooving), each scored on a 1-6 scale with color-coded severity levels (green for 1-2, yellow for 3-4, red for 5-6). The Structural Integrity Data section documents estimated repair requirements by linear feet and square footage, and identifies the presence of cracks, fractures, buckling, holes, material wastage, and weld integrity. The form also provides space for photograph documentation and additional comments, with instructions for integrating photos using Adobe Acrobat. The form was issued on 18MAR2015 and includes a Print and Reset function for electronic completion.

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SFLC-ESD-25 TANK AND VOID ASSESSMENT

FORM

GENERAL DATA Note: Use SFLC-ESD-29 for Compartments other than Tanks & Voids.

Inspector’s Name: Organization: Contact Info:

Cutter Name: Cutter Class: Hull:

Tank: Service: Tank Area: Gallons:

Solid Balast: Access Compt: Date: Assessment Reason:

ACCESS DATA

Manhole and cover condition: Tank Penetration Condition:

VENT OVERFLOW DATA

Present: Yes No Check Valve Installed: Yes No Check Valve Operates Properly: Yes No

LADDER DATA

NR of Ladder(s) Present: Yes No Ladder Damaged: Yes No Ladder Material:

TANK LEVEL INDICATOR (TLI) DATA

TLI Present in Tank: Yes No TLI Damaged: Yes No TLI Type:

SOUNDING TUBE DATA

Sounding Tube Present in Tank: Yes No Sounding Tube Damaged: Yes No Striker Plate Damaged (>50%): Yes No

CATHODIC PROTECTION DATA

Cathodic Protection in Tank: Yes No Total Zincs: Number of Zincs > 50% Depleted:

1-6 Cleanliness & Housekeeping Clean to light layer or residue 1-2 (G) Comments:

Loose accumulation scale 3-4 (Y) Impending residue and sediments 5-6 (R)

% 1-6 Coating Systems

All Painted Surfaces 1-2 (G) Comments:

3-4 (Y) 5-6 (R)

% 1-6 Structural

Corrosion 1-2 (G) Comments:

Pitting & Grooving 1-2 (G) Comments:

Page 1 of 2 18MAR2015

SFLC-ESD-25 TANK AND VOID ASSESSMENT

SHEET

Structural Integrity Data Estimated Total Linear Feet of Structure Requiring Repair: Estimated Total Square Feet of Plating Requiring Repair:

Cracks/ Fractures Present: Yes No Buckling/Deflections/ Distortions Present: Yes No Holes Present: Yes No Material Wastage Present: Yes No All Welds Intact: Yes No Structural Evaluation Recommended: Yes No

PHOTOGRAPHS

Pictures Taken (enter quantity):

Note: To add pictures to this form, Work Station must have Adobe Acrobat (not Reader) installed.

Add all photos and photo comments to a word document and save file. Open this form and click "Combine Files". Add the document with photos you've just saved and save as a new combined .pdf files.

Additional Comments:

Page 2 of 2 18MAR2015

Ladder Material:
Tank Penetration Condition:
RESET:
Inspectors Name:
Organization:
Contact Info:
Cutter Name:
Cutter Class:
Hull:
Tank:
Service:
Tank Area:
Gallons:
Solid Balast:
Access Compt:
Date:
Assessment Reason:
Manhole and cover condition:
Text8:
vent preset: Off
cv installed: Off
cv operates properly: Off
ladder present: Off
ladder damaged: Off
tli present: Off
tli damaged: Off
cp present: Off
Text2:
Total Zincs:
st present: Off
st damaged: Off
sp damaged: Off
Pitting Grooving_3:
Comments:
Clean to light layer or residue:
Comments_4:
Loose accumulation scale:
Impending residue and sediments:
Comments_2:
Comments_3:
111:
333:
222:
444:
666:
555:
777:
999:
888:
All Painted Surfaces:
All Painted Surfaces_2:
All Painted Surfaces_3:
Corrosion:
Corrosion_2:
Corrosion_3:
Pitting Grooving:
Pitting Grooving_2:
PRINT:
Additional Comments:
Estimated Total Linear Feet of Structure Requiring Repair:
Estimated Total Square Feet of Plating Requiring Repair:
Pictures Taken enter quantity:
cracks: Off
holes: Off
welds: Off
buck: Off
mar: Off
stuc: Off

File details come from the government source that posted it. Updated .