TE-BBB_AST-Visual_Inspect_Form-revision1.docx

TE-BB 11 DEC 2018

AST Visual Inspection Form

ABOVEGROUND STORAGE TANK MONTHLY VISUAL INSPECTION FORM

Facility name

Inspection Date

Street address

Use either this form or its equivalent to document monthly visual inspections required by Utah Storage Tank Regulations. Keep these records at least 12 months. However, it is advisable to keep records indefinitely, since they may be required as part of the compliance review concerning a claim for reimbursement from the Petroleum Storage Tank Fund.

1. Visible leaks on tanks, tank seams, connections, fittings or valves? No Yes If “yes,” identify tank & describe leak. Record action taken to correct problem and date done.

2. Visible leaks on aboveground piping, pipe seams, connections, fittings, flanges, threaded connections, pumps or valves? No Yes If “yes,” identify & describe leak. Record action taken to correct problem and date done.

3. Is overfill prevention equipment in good operating condition? No Yes Not applicable If “no,” identify tank. Record action taken to correct problem and date done.

Verify operation of overfill prevention equipment according to the equipment manufacturer’s instructions. Verify operation of audible alarm if it can be tested.

4. If double-walled tank:

A. Is interstice free of liquid? No Yes If “no,” identify tank. Record action taken to correct problem and date done.

B. Is interstitial monitoring equipment operating properly? No Yes Not applicable

Verify operation of interstitial monitoring equipment according to the equipment manufacturer’s instructions.

5. Secondary containment system free of tank product or other liquids/debris, such as rainwater, snowmelt, dirt, leaves, trash, etc.) No Yes Not applicable

6. Are concrete surfaces and ground free of any evidence of new leakage or spillage? No Yes If “no,” describe. Record action taken to correct problem and date done.

Signed Date

Report Suspected or Confirmed Leaks to the Dugway Environmental Compliance Division @ 435-831-3218